Chunilal Sanjeev D, Bates Shannon M
Department of Haematology, "Ginger Bread House", North Shore Hospital, Takapuna, PO Box 93-503, Auckland 1039, New Zealand.
Thromb Haemost. 2009 Mar;101(3):428-38.
A pregnant woman has a two- to five-fold higher risk of venous thromboembolism (VTE) than a non-pregnant woman of the same age and, in developed countries, she is more likely to die from fatal pulmonary embolism (PE) than from obstetric haemorrhage. The increased VTE risk is mediated through normal physiological changes of pregnancy including alterations in haemostasis that favour coagulation, reduced fibrinolysis and pooling and stasis of blood in the lower limbs. Thrombophilia, smoking, obesity, immobility and postpartum factors such as infection, bleeding and emergency surgery (including emergency caesarian section) also increase the risk of pregnancy-related VTE. The diagnosis of VTE can be safely established with acceptable radiation exposure to the fetus using readily available imaging modalities such as ultrasound, ventilation perfusion lung scanning and computed tomographic pulmonary angiography. However, the optimal diagnostic strategies still remain to be determined. If there is no contraindication to anticoagulation, commencing treatment prior to objective confirmation should be strongly considered. For the mother and fetus, effective and safe treatment is readily available with low-molecular-weight heparin (LMWH), but optimal dosing of these agents in pregnancy remains controversial. Emerging data support antepartum LMWH prophylaxis for women with previous VTE if the event was unprovoked or in the presence of thrombophilia. On the other hand, women with prior provoked VTE and no thrombophilia or women with asymptomatic thrombophilia (but a family history of VTE) can safely be managed with antepartum surveillance. Postpartum prophylaxis is recommended for women with prior VTE or thrombophilia (and a family history of VTE).
与同龄非孕妇相比，孕妇发生静脉血栓栓塞（VTE）的风险要高两到五倍，并且在发达国家，孕妇死于致命性肺栓塞（PE）的可能性高于死于产科出血的可能性。VTE风险增加是由妊娠的正常生理变化介导的，包括有利于凝血的止血改变、纤维蛋白溶解减少以及下肢血液淤积和停滞。血栓形成倾向、吸烟、肥胖、活动不便以及产后因素（如感染、出血和急诊手术，包括急诊剖宫产）也会增加与妊娠相关的VTE风险。使用超声、通气灌注肺扫描和计算机断层肺动脉造影等现成的成像方式，在胎儿接受可接受的辐射暴露情况下，可以安全地确诊VTE。然而，最佳诊断策略仍有待确定。如果没有抗凝禁忌证，应强烈考虑在客观确诊之前开始治疗。对于母亲和胎儿，低分子量肝素（LMWH）可提供有效且安全的治疗，但这些药物在孕期的最佳剂量仍存在争议。新出现的数据支持对既往有VTE且事件为非诱发性或存在血栓形成倾向的女性进行产前LMWH预防。另一方面，既往有诱发性VTE且无血栓形成倾向的女性或无症状血栓形成倾向（但有VTE家族史）的女性可通过产前监测安全管理。对于既往有VTE或血栓形成倾向（且有VTE家族史）的女性，建议进行产后预防。
