Pulmonary embolism during pregnancy: Difficulties in diagnosis and management

Мұқаба

Дәйексөз келтіру

Толық мәтін

Ашық рұқсат Ашық рұқсат
Рұқсат жабық Рұқсат берілді
Рұқсат жабық Рұқсат ақылы немесе тек жазылушылар үшін

Аннотация

Venous thromboembolic complications (VTEC) are the most common cause of direct maternal mortality during pregnancy and in the early postpartum period. Article presents a clinical observation of pulmonary embolism (PE) in female patient with pregnancy at 32 weeks, who had two risk factors for this disease – age > 35 years and the 5th number of pregnancy. PE was confirmed by echocardiography, visualized by computer tomography with contrast. The source of PE was not identified, the observed woman needed an in-depth study of hemostasis and dynamic observation in postpartum period. She was transferred to the perinatal center for delivery, in postpartum period she continued anticoagulant therapy. Thus, PE during pregnancy remains to be a rare and complex clinical situation, requires a personalized approach to the prognosis, diagnosis and treatment of VTEC in pregnants with multidisciplinary approach and continuity to achieve a favorable outcome.

Толық мәтін

Рұқсат жабық

Авторлар туралы

Oleg Uryasyev

Academician I.P. Pavlov Ryazan State Medical University of the Ministry of Healthcare of Russia

Хат алмасуға жауапты Автор.
Email: uvryasev08@yandex.ru
ORCID iD: 0000-0001-8693-4696

MD, Dr. Sci. (Medicine), professor, head of the Department of faculty therapy named after professor V.Ya. Garmash

Ресей, Ryazan

Alexandra Solovieva

Academician I.P. Pavlov Ryazan State Medical University of the Ministry of Healthcare of Russia

Email: savva2005@bk.ru
ORCID iD: 0000-0001-7896-6356

MD, Dr. Sci. (Medicine), associate professor, professor of the Department of faculty therapy named after professor V.Ya. Garmash

Ресей, Ryazan

Sergey Aksentyev

Academician I.P. Pavlov Ryazan State Medical University of the Ministry of Healthcare of Russia

Email: aksentievs@mail.ru
ORCID iD: 0000-0002-0507-520X

MD, PhD (Medicine), associate professor of the Department of faculty therapy named after professor V.Ya. Garmash

Ресей, Ryazan

Victoria Sidorova

“Network of Family Medical Centers Region No. 2” LTD

Email: vp.sidorova@mail.ru
ORCID iD: 0000-0003-0592-9428

MD, physician, cardiologist

Ресей, Ryazan

Gennady Miloserdov

“Network of Family Medical Centers Region No. 2” LTD

Email: gekkos@mail.ru
ORCID iD: 0009-0009-7402-1959

MD, head of the line “Therapy”

Ресей, Ryazan

Ekaterina Nikiforova

Academician I.P. Pavlov Ryazan State Medical University of the Ministry of Healthcare of Russia

Email: ekaterina250499@gmail.com
ORCID iD: 0000-0003-1133-9176

1st year resident in the specialty “General medical practice” of the Department of outpatient therapy, preventive medicine and general medical practice

Ресей, Ryazan

Alexey Cheskidov

Academician I.P. Pavlov Ryazan State Medical University of the Ministry of Healthcare of Russia

Email: a.v.cheskidov@yandex.ru
ORCID iD: 0000-0001-9468-0438

MD, PhD (Medicine), associate professor of the Department of nursing

Ресей, Ryazan

Әдебиет тізімі

  1. Knight M., Kenyon S., Brocklehurst P. et al. (Eds.) on behalf of MBRRACE-UK. Saving lives, improving mothers’ care. Lessons learned to inform future maternity care from the UK and Ireland confidential enquiries into maternal deaths and morbidity 2009–2012. Oxford: National Perinatal Epidemiology Unit, University of Oxford. 2014. ISBN: 978-0-9931267-1-0.
  2. Simcox L.E., Ormesher L., Tower C., Greer I.A. Pulmonary thrombo-embolism in pregnancy: Diagnosis and management. Breathe (Sheff). 2015; 11(4): 282–89. https://doi.org/10.1183/20734735.008815. PMID: 27066121. PMCID: PMC4818214.
  3. Reducing the risk of venous thromboembolism during pregnancy and the puerperium. Green-top guideline No. 37a. London: Royal College of Obstetricians and Gynaecologists. 2015. URL: https://www.rcog.org.uk/media/qejfhcaj/gtg-37a.pdf (date of access – 12.03.2025).
  4. Raia-Barjat T., Edebiri O., Chauleur C. Venous thromboembolism risk score and pregnancy. Front Cardiovasc Med. 2022; 9: 863612. https://doi.org/10.3389/fcvm.2022.863612. PMID: 35479289. PMCID: PMC9037588.
  5. Konstantinides S.V., Meyer G., Becattini C. с соавт.; Рабочая группа по диагностике и ведению острой эмболии легочной артерии Европейского общества кардиологов (ESC). Рекомендации ESC по диагностике и лечению острой легочной эмболии, разработанные в сотрудничестве с Европейским респираторным обществом (ERS), 2019. Российский кардиологический журнал. 2020; 25(8): 180–239. [Konstantinides S.V., Meyer G., Becattini C. et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonaryembolism developed in collaboration with the European Respiratory Society (ERS). Russian Journal of Cardiology. 2020; 25(8): 180–239 (In Russ.)]. https://doi.org/10.15829/1560-4071-2020-3848. EDN: NXTZZJ.
  6. Клинические рекомендации. Венозные осложнения во время беременности и послеродовом периоде. Акушерская тромбоэмболия. Российское общество акушеров-гинекологов, корпоративная некоммерческая организация «Ассоциация анестезиологов-реаниматологов», Ассоциация акушерских анестезиологов-реаниматологов. Рубрикатор клинических рекомендаций Минздрава России. 2022. ID: 723_1. Доступ: https://cr.minzdrav.gov.ru/preview-cr/723_1 (дата обращения – 12.03.2025). [Clinical guidelines. Venous complications during pregnancy and the postpartum period. Obstetric thromboembolism. Russian Society of Obstetricians and Gynecologists, Association of Anesthesiologists and Intensive Care Specialists, Russian Obstetrical Anesthesiologists and Intensivists Association. Rubricator of clinical guidelines of the Ministry of Healthcare of Russia. 2022. ID: 723_1. URL: https://cr.minzdrav.gov.ru/preview-cr/723_1 (date of access – 12.03.2025) (In Russ.)].
  7. Bukhari S., Fatima S., Barakat A.F. et al. Venous thromboembolism during pregnancy and postpartum period. Eur J Intern Med. 2022; 97: 8–17. https://doi.org/10.1016/j.ejim.2021.12.013. PMID: 34949492.
  8. Тереховская Ю.В., Окороков В.Г., Никулина Н.Н. Современная позиция антикоагулянтов при острой ТЭЛА: достижения, ограничения, перспективы. Российский медико-биологический вестник им. академика И.П. Павлова. 2019; 27(1): 93–106. [Terekhovskaya Yu.V., Okorokov V.G., Nikulina N.N. Modern position of anticoagulants in acute pulmonary embolism: Achievements, limitations, prospects. Rossiyskiy mediko-biologicheskiy vestnik imeni akademika I.P. Pavlova = I.P. Pavlov Russian Medical Biological Herald. 2019; 27(1): 93–106 (In Russ.)]. https://doi.org/10.23888/pavlovj201927193-106. EDN: ZCVWWT.
  9. Zhao Z., Zhou Q., Li X. Missed opportunities for venous thromboembolism prophylaxis during pregnancy and the postpartum period: Evidence from mainland China in 2019. BMC Pregnancy Childbirth. 2021; 21(1): 400. https://doi.org/10.1186/s12884-021-03863-w. PMID: 34030656. PMCID: PMC8142288.
  10. Alsheef M.A., Alabbad A.M., Albassam R.A. et al. Pregnancy and venous thromboembolism: Risk factors, trends, management, and mortality. Biomed Res Int. 2020; 2020: 4071892. https://doi.org/10.1155/2020/4071892. PMID: 32351991. PMCID: PMC7174915.
  11. Ram S., Ram H.S., Neuhof B. et al. Venous thromboembolism during pregnancy: Trends, incidence, and risk patterns in a large cohort population. Int J Gynaecol Obstet. 2023; 160(3): 962–68. https://doi.org/10.1002/ijgo.14414. PMID: 35979847.
  12. Committee Opinion No. 723: Guidelines for diagnostic imaging during pregnancy and lactation. Obstet Gynecol. 2017; 130(4): e210–16. https://doi.org/10.1097/AOG.0000000000002355. PMID: 28937575.
  13. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins – Obstetrics. ACOG Practice Bulletin No. 196: Thromboembolism in pregnancy. Obstet Gynecol. 2018; 132(1): e1–e17. https://doi.org/10.1097/AOG.0000000000002706. PMID: 29939938.
  14. Bates S.M., Rajasekhar A., Middeldorp S. et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: Venous thromboembolism in the context of pregnancy. Blood Adv. 2018; 2(22): 3317–59. https://doi.org/10.1182/bloodadvances.2018024802. PMID: 30482767. PMCID: PMC6258928.
  15. Middeldorp S., Nieuwlaat R., Kreuziger L.B. et al. American Society of Hematology 2023 guidelines for management of venous thromboembolism: Thrombophilia testing. Blood Adv. 2023; 7(22): 7101–38. https://doi.org/10.1182/bloodadvances.2023010177. PMID: 37195076. PMCID: PMC10709681.
  16. Шевлякова Т.В., Петрова Е.И., Микитюк Е.Н. с соавт. Клинический случай ведения беременной после перенесенного эпизода массивной тромбоэмболии легочной артерии. Вестник акушерской анестезиологии. 2018; 7(9): 32–39. [Shevlyakova T.V., Petrova E.I., Mikityuk E.N. et al. Clinical case of management of a pregnant woman after an episode of massive pulmonary embolism. Vestnik akusherskoy anesteziologii = Obstetric Anesthesia Digest. 2018; 7(9): 32–39 (In Russ.)].

Қосымша файлдар

Қосымша файлдар
Әрекет
1. JATS XML
Жүктеу
2. Fig. 1. Electrocardiogram of the observed patient upon admission

Жүктеу (126KB)
Метадеректер
3. Fig. 2. Results of echocardiography of the observed patient: A - from 11/14/2019, B - from 11/29/2019

Жүктеу (186KB)
Метадеректер

© Bionika Media, 2025