Crosby David A, Ryan Kevin, McEniff Niall, Dicker Patrick, Regan Carmen, Lynch Caoimhe, Byrne Bridgette
Maternal Medicine Service, Coombe Women and Infants University Hospital, Dublin 8, Ireland.
National Centre of Hereditary Coagulation Disorders, Ireland.
Eur J Obstet Gynecol Reprod Biol. 2018 Mar;222:25-30. doi: 10.1016/j.ejogrb.2017.12.035. Epub 2017 Dec 21.
Venous thromboembolism remains one of the leading causes of maternal mortality in the developed world. Retrievable inferior vena cava (IVC) filters have a role in the prevention of lethal pulmonary emboli when anticoagulation is contraindicated or has failed [1]. It is unclear whether or not the physiological changes in pregnancy influence efficacy and complications of these devices. The decision to place an IVC filter in pregnancy is complex and there is limited information in terms of benefit and risk to the mother. The objective of this study was to determine the efficacy and safety of these devices in pregnancy and to compare these with rates reported in the general population.
The aim of this study was report three recent cases of retrievable IVC filter use in pregnant women in our department and to perform a systematic review of the literature to identify published cases of filters in pregnancy. The efficacy and complication rates of these devices in pregnancy were estimated and compared to rates reported in the general population in a recent review [2]. Fisher's exact test was used for statistical analysis.
In addition to our three cases, 16 publications were identified with retrievable IVC filter use in 40 pregnant women resulting in a total of 43 cases. There was no pulmonary embolus in the pregnant group (0/43) compared to 57/6291 (0.9%) in the general population. Thrombosis of the filter (2.3% vs. 0.9%, p = 0.33) and perforation of the IVC (7.0% vs 4.4%, p = 0.44) were more common in pregnancy compared to the general population but the difference was not statistically significant. Failure to retrieve the filter is more likely to occur in pregnancy (26% vs. 11%, p = 0.006) but this did not correlate with the type of device (p = 0.61), duration of insertion (p = 0.58) or mode of delivery (p = 0.37).
Data for retrievable IVC filters in pregnancy is limited and there may be a publication bias towards complicated cases. This study shows that the filter appears to protect against PE in pregnancy but the numbers are small. Complications such as filter thrombosis and IVC penetration appear to be higher in pregnancy but this difference is not statistically significant. It is not possible to retrieve the device in one out of every four pregnant women. This has implications in terms of long term risk of lower limb thrombosis and post thrombotic syndrome. The decision to use an IVC filter in pregnancy needs careful consideration by a multidisciplinary team. The benefit and risk assessment should be individualised and clearly outlined to the patient.
在发达国家，静脉血栓栓塞症仍然是孕产妇死亡的主要原因之一。当抗凝治疗禁忌或失败时，可回收下腔静脉（IVC）滤器在预防致命性肺栓塞方面发挥着作用[1]。尚不清楚妊娠期间的生理变化是否会影响这些装置的疗效和并发症。在妊娠期间放置IVC滤器的决定很复杂，关于对母亲的益处和风险的信息有限。本研究的目的是确定这些装置在妊娠中的疗效和安全性，并将其与普通人群中报告的发生率进行比较。
本研究的目的是报告我们科室最近三例在孕妇中使用可回收IVC滤器的病例，并对文献进行系统回顾，以确定已发表的妊娠期间使用滤器的病例。估计这些装置在妊娠中的疗效和并发症发生率，并与最近一篇综述中普通人群报告的发生率进行比较[2]。采用Fisher精确检验进行统计分析。
除了我们的三例病例外，还确定了16篇关于在40名孕妇中使用可回收IVC滤器的文献，共43例。妊娠组未发生肺栓塞（0/43），而普通人群中为57/6291（0.9%）。与普通人群相比，滤器血栓形成（2.3%对0.9%，p = 0.33）和IVC穿孔（7.0%对4.4%，p = 0.44）在妊娠中更常见，但差异无统计学意义。妊娠期间更有可能无法取出滤器（26%对11%，p = 0.006），但这与装置类型（p = 0.61）、置入持续时间（p = 0.58）或分娩方式（p = 0.37）无关。
妊娠期间可回收IVC滤器的数据有限，可能存在对复杂病例的发表偏倚。本研究表明，滤器似乎能预防妊娠期间的肺栓塞，但病例数量较少。滤器血栓形成和IVC穿透等并发症在妊娠中似乎更高，但差异无统计学意义。每四名孕妇中就有一人无法取出该装置。这对下肢血栓形成和血栓后综合征的长期风险有影响。在妊娠期间使用IVC滤器的决定需要多学科团队仔细考虑。益处和风险评估应个体化并向患者明确说明。
