Symptoms of thrombophlebitis or lack not allow reliable information for diagnosis, severity of the disease or at risk of developing an embolism. Thromboembolic disorders can be associated with no symptoms, with only minor or with pronounced symptoms. Edema, cramps and tenderness in the calves that normally occur during pregnancy that can mimic signs Homans’sche.
In the US, thromboembolic diseases – deep vein thrombosis (DVT – Deep vein thrombosis (DVT)) or pulmonary embolism (PE – pulmonary embolism (PE)) – the leading cause of maternal mortality. During pregnancy, there is an increased risk of thromboembolism, because the venous capacity and the venous pressure in the lower extremities to rise, leading to a slower flow rate of the blood (stasis), and because pregnancy causes a moderate hypercoagulability. Nevertheless, most thromboembolism develop post partum by vascular injury during birth. A caesarean section also increases the risk. Symptoms of thrombophlebitis or lack not allow reliable information for diagnosis, severity of the disease or at risk of developing an embolism. Thromboembolic disorders can be associated with no symptoms, with only minor or with pronounced symptoms. Edema, cramps and tenderness in the calves that normally occur during pregnancy that can mimic signs Homans’sche. Diagnosis Doppler sonography or occasionally contrast-enhanced computed tomography of deep venous thrombosis spiral CT for pulmonary embolism diagnosis of DVT is most often provided by Doppler sonography. in the puerperium Nonetheless, if there is a suspicion of thrombosis of the iliac, ovarian or other pelvic veins in inconspicuous Doppler ultrasound and plethysmographic findings, a contrast-enhanced computerized tomography (CT) is performed. The diagnosis of pulmonary embolism is being increasingly by a helical CT than by a ventilation-perfusion scintigraphy because the radiation dose is lower and the diagnostic sensitivity is comparable. If the diagnosis of pulmonary embolism is uncertain, pulmonary angiography must be performed. Treatment Similar to non-pregnant patients, except the avoidance of warfarin In women with an increased risk prophylactic low molecular weight heparin during pregnancy and for 6 weeks after birth If a deep vein thrombosis or pulmonary embolism detected during pregnancy, the anticoagulant of choice is a low molecular weight heparin (LMWH) because this is not cross the placenta because of its molecular size. It does not cause maternal osteoporosis or probably no thrombocytopenia as they can (? 6 months) arise from unfractionated heparin by prolonged use. Warfarin crosses the placenta and can cause fetal abnormalities or fetal death (see table: Some drugs with adverse effects during pregnancy). The indications for thrombolysis during pregnancy are similar to non-pregnant patients. If a pulmonary embolism, despite effective anticoagulation relapses, a surgical intervention is indicated, generally the placement of a filter (z. B. Greenfield-tip) in the inferior vena cava just distal of the renal vessels. If women develop deep vein thrombosis or pulmonary embolism during a previous pregnancy, or had an underlying thrombophilia, they will be prophylactically with low molecular weight heparin (z. B. Enoxaparin 40 mg sc 1 time / day), beginning on the day of pregnancy diagnosis and continuously to 6 weeks treatment post partum.