Document Detail


Pulmonary embolism during and after pregnancy.
MedLine Citation:
PMID:  16215350     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Venous thromboembolic disease is among the most common causes of morbidity and mortality during pregnancy. The clinical evaluation alone is insufficient for the diagnosis of venous thromboembolic disease, and the normal pregnant state makes this evaluation even more challenging. DIAGNOSIS: Objective testing is the mainstay of diagnosis, including compression ultrasound, impedance plethysmography, ventilation-perfusion scanning, computed tomography scanning, and pulmonary angiography. All of these tests can be safety performed during pregnancy. TREATMENT: If deep vein thrombosis or pulmonary embolism is diagnosed, anticoagulation should be initiated. Either (unfractionated) heparin or low molecular weight heparin is an acceptable treatment for acute venous thromboembolic disease. Both have risks and benefits, but both can be used safely during pregnancy. Intravenous heparin is the treatment of choice surrounding delivery due to its short half life. Because of the risk of adverse effects on the fetus, warfarin is not generally used during pregnancy. Unstable pulmonary embolism is difficult to treat during pregnancy, as there are minimal data regarding the safety and efficacy of thrombolytic therapy, inferior vena cava filters, and embolectomy during pregnancy. Case reports and case series suggest that thrombolytic therapy may be associated with lower risks of fetal loss than embolectomy. CONCLUSIONS: Venous thromboembolic disease is a significant cause of morbidity and mortality during pregnancy and the puerperal period. Objective testing is critical to establish the diagnosis and can be safely performed during pregnancy. Anticoagulation with heparin is the mainstay of therapy during the pregnancy, but patients may be transitioned to warfarin after delivery.
Authors:
Sarah E Stone; Timothy A Morris
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Critical care medicine     Volume:  33     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2005 Oct 
Date Detail:
Created Date:  2005-10-10     Completed Date:  2005-12-20     Revised Date:  2006-10-13    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S294-300     Citation Subset:  AIM; IM    
Affiliation:
Department of Medicine, University of California, San Diego, San Diego, CA, USA.
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MeSH Terms
Descriptor/Qualifier:
Anticoagulants / therapeutic use
Breast Feeding
Critical Care*
Female
Heparin / therapeutic use
Humans
Pregnancy
Pregnancy Complications / diagnosis,  drug therapy*,  physiopathology*
Puerperal Disorders / diagnosis,  drug therapy,  physiopathology
Pulmonary Embolism / diagnosis,  drug therapy*,  physiopathology*
Venous Thrombosis / diagnosis,  drug therapy,  physiopathology
Chemical
Reg. No./Substance:
0/Anticoagulants; 9005-49-6/Heparin
Comments/Corrections
Comment In:
Crit Care Med. 2006 Oct;34(10):2701; author reply 2701-2   [PMID:  16983284 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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