Pulmonary embolism in pregnant women and women in childbirth

Authors

  • S. O. Siromaha SI «Amosov National Institute of Cardiovascular Surgery of the NAMS of Ukraine», Kyiv, Ukraine
  • A. O. Rusnak SI «Amosov National Institute of Cardiovascular Surgery of the NAMS of Ukraine», Kyiv, Ukraine
  • S. P. Lezhnenko SI «Amosov National Institute of Cardiovascular Surgery of the NAMS of Ukraine», Kyiv, Ukraine
  • A. O. Ogorodnyk SI «Amosov National Institute of Cardiovascular Surgery of the NAMS of Ukraine», Kyiv SI «Institute of Pediatrics, Obstetrics and Gynecology named of academician O.M. Lukyanova of the NAMS of Ukraine», Kyiv, Ukraine https://orcid.org/0000-0002-6871-7935
  • Iu. V. Davydova SI «Amosov National Institute of Cardiovascular Surgery of the NAMS of Ukraine», Kyiv SI «Institute of Pediatrics, Obstetrics and Gynecology named of academician O.M. Lukyanova of the NAMS of Ukraine», Kyiv, Ukraine https://orcid.org/0000-0001-9747-1738
  • V. V. Lazorishinets SI «Amosov National Institute of Cardiovascular Surgery of the NAMS of Ukraine», Kyiv, Ukraine

DOI:

https://doi.org/10.15574/PP.2019.80.30

Keywords:

venous thromboembolism, pregnancy, postpartum period, cardiac surgery

Abstract

The aim is to reduce maternal mortality and disability rates by improving diagnostic and treatment programs in pregnant women / women with venous thromboembolism (VTE) and its most dangerous form — pulmonary embolism (PE).
Patients and methods. In accordance with the current international guidelines for action on suspicion of PE, as well as taking into account the national multidisciplinary team of Obstetric Cardiology and Cardiac Surgery, a modified algorithm for examination and medical support of pregnant women / parturient women was substantiated and implemented. Methods for the treatment of calves in pregnant women / women in childbirth depending on their clinical condition, the result of stratification of the severity of calves and the risk of mortality are presented. According to the experience of a national multidisciplinary team (pregnancy heart team), formed in 2013 on the basis of two academic institutions — NICVS named after M.M. Amosov National Academy of Medical Sciences of Ukraine and Institute of Peditrics, Obstetrics and Gynecology named after academician O.Lukyanova of the NAMS of Ukraine, the algorithm of treatment of acute massive PE in pregnant women / parturient women in childbirth is presented. Clinical cases of treatment of acute VTE in pregnant women /parturient women in childbirth are given. These cases present the practical and scientific interest from the point of view of the clinician and allow to identify the shortcomings of the support and the complications obtained.
Results. Venous thromboembolism is a threatening extragenital pathology, and acute PE is the leading cause of maternal mortality in the world. The diagnostic algorithm for VTE is aimed at the timely detection and treatment of a high-risk massive body. Thromboprophylaxis in pregnant women / parturient women in childbirth with risk factors for VTE is an important component in the prevention of the development of DVT. The choice of the optimal method (or combination of methods) for the treatment of BOD should be made personalized after stratification of the severity of the lesions and the risk of 30-day mortality.
Conclusions. A multidisciplinary approach at all stages of VTE diagnosis in pregnant women /parturient women in childbirth is a necessary component of cardiac and obstetric care for pregnant women with VTE and enables efficient use of resources (avoiding duplication of functions); extends control capabilities; improves the quality of assistance (reduction of time, unification of approaches, activities under jointly developed protocol); enhances the knowledge and value of shared clinical and scientific experience, which is the key to increasing efficiency in solving further clinical problems.
The study was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of the institutions mentioned. The informed consent of women was obtained from the studies.
The authors declare no conflict of interest.

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No. 4(80) (2019): Ukrainian Journal of Perinatology and Pediatrics

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