Venous thromboembolism during pregnancy, postpartum or during contraceptive use

Abstract

Venous thromboembolism (VTE) is a leading cause of maternal death during pregnancy or postpartum, and in women using hormonal contraceptives. However, important issues concerning its natural history and therapy remain unsolved, and most of the protocols for treatment of VTE in this patient population are based on data extrapolated from other populations. RIETE is an ongoing registry of consecutive patients with objectively confirmed, symptomatic, acute VTE. We examined the clinical characteristics and three-month outcome of all enrolled women with pregnancy, postpartum or using hormonal contraceptives. As of December 2008, 173 pregnant women, 135 postpartum, and 798 contraceptive users were enrolled. Of these, 438 (40%) presented with pulmonary embolism (PE) and 668 with deep-vein thrombosis (DVT). Most women with acute PE had dyspnea (72%) or chest pain (75%), but only 2.0% had hypoxaemia. During the three-month study period, five women (0.45%; 95% CI: 0.17-1.00) died (3 had fatal PE), 13 (1.18%; 95% CI: 0.66-1.95) had VTE recurrences, and seven (0.63%; 95% CI: 0.28-1.25) major bleeding. Two of the three women with fatal PE died during the first few hours after arriving at the emergency ward, with no time to start any therapy. The outcome of pregnant or postpartum women with VTE is similar to that in contraceptive users, even though the treatment is different. The non-specific nature of PE signs may have caused some delay in PE diagnosis.

Methodology for Ventilation/Perfusion SPECT

“…41 Pregnant women represent a young and healthy population, in which the interpretation of lung perfusion scintigraphy is usually straightforward. 42 Although the radiation dose from V/Q SPECT is low, it is important to further minimize radiation exposure to the proliferating breast tissue.…”

Pulmonary embolism: clinical guidelines of European Society of Cardiology (2014).The Task Force of the European Society of Cardiology for diagnosis and management of pulmonary embolism

“…У женщин детородного возраста наиболее частым предрасполагающим фактором ВТЭ являются перо ральные контрацептивы [21,22]. Если ВТЭ развива ется во время беременности, она становится серьез ной причиной материнской летальности [23].…”

“…При разных вариантах рака риск ВТЭ варьируется [16,17]; наибольший риск при сутствует при гематологических злокачественных заболеваниях, раке легкого, желудочно кишечного тракта, поджелудочной железы и злокачественных опухолях головного мозга [18,19]. Более того, рак является мощным фактором риска общей леталь ности после эпизода ВТЭ [20].У женщин детородного возраста наиболее частым предрасполагающим фактором ВТЭ являются перо ральные контрацептивы [21,22]. Если ВТЭ развива ется во время беременности, она становится серьез ной причиной материнской летальности [23].…”

Critical predictors of pulmonary embolism

“…This is contrary to previous reports in the literature. [11][12][13] It is possible that this is due to an unperceived confounding factor. As there were few pregnant women in this sample, this subpopulation will need further study to determine the association with VTE.…”