Rath W, Tsikouras P, von Tempelhoff G-F
Medizinische Fakultät Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel.
Department of Obstetrics and Gynecology, Democritus University of Thrace, Alexandroupolis, Greece.
Z Geburtshilfe Neonatol. 2016 Jun;220(3):95-105. doi: 10.1055/s-0042-106654. Epub 2016 Jun 17.
Venous thromboembolism (VTE) is one of the leading causes of maternal deaths worldwide. Due to the increasing number of pregnant women with risk factors, the incidence of VTE has risen over the past decades. Mortality and morbidity of VTE are potentially preventable, since more than two-thirds of these women have identifiable risk factors and may benefit from appropriate thromboprophylaxis. The cornerstones for prevention of VTE are the individual and careful assessment of preexisting and new-onset/transient risk factors during pregnancy as well as before and after delivery and a risk-stratified pharmacological thromboprophylaxis. Current recommendations for thromboprophylaxis must rely on consensus statements and expert opinions. The recently published German AWMF-Guideline 003/001 and the Green-top Guideline No. 37a from the Royal College of Obstetricians and Gynaecologists (RCOG) are discussed. The RCOG Guideline recommends antenatal thromboprophylaxis in women with previous VTE, high-risk thrombophilia or in the presence of ≥ 4 risk factors from the beginning of pregnancy, in women with 3 current risk factors from 28 weeks of gestation. After delivery women with intermediate risk should receive prophylactic LMWH for at least 10 days and women with high risk for 6 weeks postnatally. All women who have had an elective caesarean section and who have>1 additional risk factor should be given prophylactic NMH as well as all women who have had a caesarean section in labour or an emergency caesarean section. At the onset of labour, in case of any vaginal bleeding, prior to scheduled labour induction or at least 12 h before an elective caesarean section, antenatal LMWH prophylaxis should be discontinued. LMWH prophylaxis can be continued 4-6 h after vaginal delivery and 6-12 h after caesarean delivery when women do not have an increased risk of haemorrhage. Current guidelines recommend weight-based LMWH.
静脉血栓栓塞症（VTE）是全球孕产妇死亡的主要原因之一。由于具有风险因素的孕妇数量不断增加，在过去几十年中VTE的发病率有所上升。VTE的死亡率和发病率具有潜在的可预防性，因为超过三分之二的此类女性具有可识别的风险因素，并且可能从适当的血栓预防中获益。预防VTE的基石是在孕期以及分娩前后对既往和新出现/短暂的风险因素进行个体化且细致的评估，以及进行风险分层的药物性血栓预防。当前关于血栓预防的建议必须依赖于共识声明和专家意见。本文将讨论最近发布的德国AWMF指南003/001以及皇家妇产科学院（RCOG）的第37a号绿帽指南。RCOG指南建议，有既往VTE、高风险血栓形成倾向或孕期开始时存在≥4个风险因素的女性，以及妊娠28周起有3个当前风险因素的女性，应进行产前血栓预防。分娩后，中度风险的女性应接受至少10天的预防性低分子肝素治疗，高风险的女性产后应接受6周的治疗。所有接受择期剖宫产且有>1个额外风险因素的女性，以及所有在分娩时进行剖宫产或急诊剖宫产的女性，均应给予预防性非口服抗凝药。在分娩开始时、出现任何阴道出血时、计划引产之前或择期剖宫产至少12小时之前，应停止产前低分子肝素预防。当女性没有出血风险增加时，阴道分娩后4 - 6小时和剖宫产术后6 - 12小时可继续进行低分子肝素预防。当前指南推荐基于体重的低分子肝素。
