Caprini血栓风险评估表评估妊娠期及产褥期静脉血栓栓塞疾病风险的有效性研究

目的探讨Caprini血栓风险评估表预测妊娠期及产褥期静脉血栓栓塞疾病(venous thromboembolism,VTE)发病风险的有效性。方法采用病例对照研究,回顾性分析2004年1月至2015年12月入住福建医科大学附属第一医院的39例妊娠期及产褥期发生VTE的患者,作为病例组;随机选取同期妊娠期及产褥期非VTE患者156例作为对照组。根据Caprini血栓风险评估表对两组患者进行Caprini评分、危险度分级,分析危险度分级与VTE发病风险的相关关系,并分析Caprini风险评估量表中影响妊娠期及产褥期VTE发病的主要危险因素。结果妊娠期及产褥期血栓发生率为0.13%。病例组的VTE评分(5.7±2.9)高于对照组(3.6±1.7),差异有统计学意义(P0.05)。病例组的高危和极高危级别所占比例最大,为94.8%,比例高于对照组(75.0%),两组Caprini危险度分级的构成之间差异有统计学意义(P0.05)。Caprini风险评估量表的危险度分级与VTE发病存在显著的正相关关系(P0.05),极高危级是影响VTE发病的主要危险因素。随着危险度分级的升高,妊娠期及产褥期患者发生VTE的风险随之升高。极高危(评分≥5)患者发生VTE的风险为低中危(评分0~2分)患者的16.107倍。Caprini风险评估表中的静脉曲张、BMI≥25、需卧床休息的内科患者、大手术(手术时间45 min)是妊娠期及产褥期发生VTE的主要危险因素。结论Caprini血栓风险评估表在妊娠期及产褥期患者中也适用,对妊娠期及产褥期VTE发病风险有很好的预测性,在临床上适合推广应用。     

妊娠期及产褥期静脉血栓栓塞16例临床分析

目的 探讨妊娠期和产褥期静脉血栓栓塞(venous thromboembolism,VTE)的高危因素、病因、诊断、治疗和预防. 方法 对1992年1月至2011年4月间本院收治的16例妊娠期及产褥期VTE患者的临床资料进行回顾性分析.采用病例对照研究方法,配对t检验比较VTE患者(病例组)发生VTE前与正常孕妇(对照组)血常规及凝血功能的差异. 结果 收治的16例VTE患者经彩色多普勒超声或CT肺动脉造影确诊,5例(31.2％)发生于妊娠期,11例(68.8％)发生于产褥期;2例(12.5％)继发肺血栓栓塞;≥35岁者6例(37.5％);有妊娠合并症或并发症者12例(75.0％).病例组发病前红细胞压积为0.29±0.06,低于对照组(0.39±0.02),差异有统计学意义(t=4.56,P=0.01),但组间凝血功能的差异无统计学意义.经抗凝、手术及对症支持等治疗,15例VTE患者恢复良好出院,1例继发肺血栓栓塞患者因合并风湿性心脏病,在抗凝治疗后仍持续性休克,放置下腔静脉滤网后行溶栓治疗,但出现持续呼吸道出血,抢救无效死亡. 结论 产褥期较妊娠期更易发生VTE,筛查VTE的实验室指标仍需进一步研究,抗凝是VTE的首选治疗方法.对有VTE高危因素的孕产妇应积极预防、早期诊治,以减少并发症及远期后遗症的发生.     

妊娠期及产褥期静脉血栓栓塞症的危险因素及其评估策略

妊娠期及产褥期是静脉血栓栓塞症( venous thromboembolism,VTE)发生的明确高危时期。 在此期间,VTE 的发病率约为1 / 1600。 由于特殊的生理和解剖变化,女性在妊娠期及产褥期发生的 VTE 的风险以及因 VTE 引起的死亡率均明显高于正常人群。 VTE 可以表现为单纯的深静脉血栓形成( deep vein throm- bosis,DVT),约占 VTE 总数 75% ~ 80% ,也可能出现 因 DVT 的血栓脱落进一步发生肺栓塞(pulmonary em- bolism,PE),约占 20% ~ 25% 。 PE 是死亡率极高的 急危重症,临床应给予高度重视。     

126例孕产妇静脉血栓栓塞症危险因素分析

目的:分析妊娠相关静脉血栓栓塞症(venous thromboembolism,VTE)的发病特点及危险因素.方法:收集同济大学附属第一妇婴保健院(我院)产科2019年1月—2021年3月诊断为VTE的孕产妇临床资料共126例,回顾性分析其发病特点和危险因素.结果:126例妊娠期及产褥期VTE患者,6.35％(8/12...     

妊娠相关静脉血栓栓塞症的预防和治疗

妊娠相关静脉血栓栓塞症(pregnancy associated venous thromboembolism,PA-VTE)系指妊娠期及产褥期发生的静脉血栓栓塞症(venous thromboembolism,VTE)。PA-VTE可以发生在妊娠的不同时期,产褥期风险最高,发生率为产前的2～5倍,尤以产后6周内风险最高。PA-VTE危害极大,目前已成为发达国家孕产妇死亡的重要原因之一。PA-VTE的提出,意在强调其预防和诊治应基于妊娠这一特殊阶段的病理生理学特征,制定专科管理规范。而目前一些国家已有针对PA-VTE的防治指南和共识,但中国仅在少数VTE管理指南中提及对该类疾病的防治,具体防治方案仍不明确,临床中迫切需要制定适合我国妊娠患者VTE预防和治疗的指南,以规范临床实践。本文综述PA-VTE病理生理学特征、临床筛查、预防、治疗和我国临床实践现状。     

妊娠期及产褥期静脉血栓栓塞症预防和诊治专家共识

静脉血栓栓塞症（VTE）包括深静脉血栓形成和肺栓塞。妊娠期和产褥期发生VTE的风险明显高于非孕期,筛查和识别VTE的高危因素及临床表现、采取相应防治措施是降低VTE所致孕产妇死亡的重要手段。中华医学会妇产科学分会产科学组在参考国内外相关指南的基础上,结合高级别临床研究证据和我国的实际情况,组织全国的产科专家共同讨论并编...     

妊娠期和产褥期静脉血栓栓塞的预防：2020年昆士兰临床指南解读

        静脉血栓栓塞症（venous thromboembolism,VTE）可分为深静脉血栓形成（deep vein thrombosis,DVT）和肺动脉栓塞（pulmonary embolism,PE）。孕产妇因其特殊的生理状态,在妊娠期及产褥期发生VTE的风险较非妊娠期显著增加［1］。近年来,随着孕产妇高龄、肥胖、妊娠合并症和并发症等风险因素增加,VTE发病率和病死率不断上升［2-4］。 浏览更多请关注本刊微信公众号及当期杂志。     

不得不防的妊娠相关血栓栓塞性疾病的预防与处理

妊娠相关血栓栓塞性疾病主要是静脉血栓栓塞症(venous thromboembolism,VTE),包括深静脉血栓形成(deep vein thrombosis,DVT)和肺栓塞(pulmonary embolism,PE),其中DVT占75％～80％,而PE占20％～25％.妊娠是VTE的独立危险因素,妊娠期和产褥期...     

妊娠期及产褥期肺血栓栓塞症的早期识别与防治策略

肺血栓栓塞症 是静脉血栓栓塞症(pulmonary thromboembolism,PTE) ( venous thromboembolism,VTE) 的 严重并发症,妊娠期及产褥期的肺血栓栓塞主要来源 于下肢深静脉血栓脱落阻塞肺动脉后引起循环异常 和心功能障碍。 由于孕产妇在妊娠这一特殊时期的 生理变化特点,导致孕产妇在妊娠期 PTE 的发生率明 显高于非孕同龄妇女,而在产褥期 PTE 的发生率更 高。 文献报道,妊娠期及产褥期 PTE 的发病率高达 0. 09‰ ~ 0. 7‰,病死率高达 20% ~ 30% [1] 。 典型妊 娠期及产褥期 PTE 发生时,患者及胎儿常处于危险境 界,救治较为困难。 因而,对于妊娠期及产褥期 PTE, 早期识别及防治尤为重要,现针对妊娠期及产褥期 PTE 的早期识别与防治策略问题进行探讨。     

妊娠期及产褥期静脉血栓栓塞症的流行病学特征及发生机制

静脉血栓栓塞症( venous thromboembolism,VTE) 是指血液在静脉内异常凝集,形成血栓阻塞管腔而导 致的静脉回流障碍性疾病。 VTE 主要包括深静脉血 栓形成( deep venous thrombosis,DVT) 和肺栓塞( pul- monary embolism,PE)。 妊娠期及产褥期间机体发生 特殊的生理和解剖等改变,使得孕产妇同时具备静脉 血栓形成的 Virchow 三要素[1] ,即血管壁损伤、血流滞 缓和血液高凝,从而成为 VTE 的高危人群,其 VTE 的 发病率及死亡率均高于正常非孕人群。     

妊娠合并复发性下肢静脉血栓伴家族性血栓病史一例并文献复习

分析吉林大学第二医院收治的1例妊娠合并复发性下肢静脉血栓伴家族性血栓病史病例的临床资料,并回顾分析既往相关文献及资料。妊娠妇女发生下肢静脉血栓栓塞症(VTE)风险是非妊娠妇女的5倍左右,既往下肢VTE史、家族性血栓病史均是VTE的高危因素。本例患者既往产褥期下肢静脉血栓溶栓治疗后再次复发,此次给予抗凝治疗后未出现不良后果。对于VTE高危型孕产妇,适当的抗凝治疗利大于弊,产褥期格外需要重视。如今剖宫产率的增加更提高了术后VTE发生的风险,因此产前的评估、产后的严密观察以及适当的抗凝治疗可以降低妊娠相关的复发性VTE发生率。     

妊娠合并乙肝病毒感染与早产的相关性研究

目的分析妊娠相关静脉血栓栓塞症(pregnancy associated venous thromboembolism, PA-VTE)的临床特点。方法回顾性分析2010年10月至2019年4月年北京大学第三医院产科收治的PA-VTE 53例临床资料。结果(1) 53例患者中,30例(56.6%)发生于产褥期,23例(43.4%)发生于妊娠期;(2)肺栓塞4例(7.55%),均为急诊剖宫产术后发生;(3)晚期妊娠8例(15.1%),中期妊娠4例(7.5%),早期妊娠11例(20.8%),妊娠早中期VTE多合并非妊娠相关高危因素;(4)剖宫产后产褥期23例(76.7%),阴道分娩后7例(23.3%),均无VTE家族史。结论不同妊娠阶段PA-VTE致病因素不同,妊娠早期多与血栓前状态等非产科因素相关,随妊娠进展至产褥期,妊娠相关高危因素逐步增加,分娩期并发症是产褥期PA-VTE重要因素。     

妊娠和产褥期静脉血栓栓塞的临床特征及治疗

目的分析妊娠和产褥期静脉血栓栓塞(venous thromboembolism,VTE)患者的临床特征、治疗方式及妊娠结局。方法本研究为回顾性研究。研究对象为2014年1月至2017年12月山西医科大学附属大医院血管外科收治的81例妊娠和产褥期VTE患者。根据VTE的发生时机,分析妊娠和产褥期发病患者的临床资料。采用t检验、秩和检验或χ^2检验(或Fisher精确概率法)对数据进行统计分析。结果(1)研究对象年龄为(30.9±5.2)岁,20例(24.7%)年龄≥35岁。妊娠期患者41例(50.6%),产褥期患者40例(49.4%)。产褥期发病的患者中,34例(85.0%)发生在产后30 d内。(2)VTE首发症状和体征主要表现为肿胀[43.4%,33/76,剔除5例单纯肺血栓栓塞症(pulmonary thromboembolism,PTE)患者]和疼痛(28.9%,22/76),以急性发病为主。血栓范围以周围型为主(61.8%,47/76),其中妊娠期患者多为周围型(80.0%,32/40),而产褥期患者以混合型为主(44.4%,16/36,χ^2=13.417)。血栓部位主要是下肢深静脉(74.1%,60/81),其中妊娠期患者下肢深静脉血栓(deep venous thrombosis,DVT)较多(87.8%,36/41),而产褥期DVT合并PTE较多(30.0%,12/40,χ^2=7.961)。累及静脉以肌间静脉最多(72.4%,55/76),其中妊娠期患者主要累及肌间静脉(85.0%,34/40),而产褥期患者累及肌间(58.3%,21/36)、股(58.3%,21/36)、腘(50.0%,18/36)、髂(47.2%,17/36)、胫(44.4%,16/36)和腓(38.8%,14/36)等多条静脉。(3)占比例最高的危险因素是年龄≥35岁(24.7%,20/81);其次是抗凝血酶缺乏(23.5%,19/81)和妊娠期高血压疾病(21.0%,17/81)。不同危险因素在妊娠期和产褥期患者间的分布差异均无统计学意义。产褥期患者D-二聚体水平较高[1029(639~1778)与619(355~1117)μg/L,Z=-3.336,P<0.001]。(4)所有患者均行系统抗凝治疗。24例患者(29.6%,包括妊娠期5例,产褥期19例)因血栓范围广泛而行溶栓治疗。住院时间为(7.3±2.1)d。(5)41例妊娠期VTE患者中,治疗后9例(21.9%)选择引产,其余32例继续妊娠至分娩,包括26例剖宫产,6例经阴道分娩;8例(25.0%)为早产儿,1例(3.1%)为巨大儿。结论孕产妇相关VTE主要发生于妊娠晚期和产后30 d内。其中产褥期VTE累及静脉多、血栓范围广。对于年龄≥35岁、抗凝血酶缺乏或合并妊娠期高血压疾病的孕产妇,要尤其警惕VTE。妊娠期VTE可能影响患者的妊娠结局,要密切观察。     

Factor V Leiden and prothrombin 20210 G-A mutations in controls and in patients with thromboembolic events during pregnancy or the puerperium

Factor V Leiden and prothrombin 20210 G-A mutations are independent risk factors for venous thrombosis. We studied the frequency of these mutations in 35 patients who had thromboembolic events during pregnancy and puerperium, and in 32 women who had a history of uncomplicated pregnancy, delivered either vaginally or by cesarean section, and did not have a past history of thromboembolism. Factor V Leiden mutation was present in 7 patients (20%) in the study group. Of these 7 patients, 1 was homozygote, whereas the remaining 6 were heterozygote for the mutation. Prothrombin 20210 G-A mutation was present in 2 patients (5.7%) in the study group. In the control group none of the 32 patients was positive for the factor V Leiden and prothrombin 20210 G-A mutations. Our findings indicate that the factor V Leiden mutation is an important risk factor for thromboembolic disease during pregnancy or puerperium.     

PREVENTION AND TREATMENT OF VENOUS THROMBOEMBOLISM (VTE) IN OBSTETRICS

OBJECTIVE: to identify risk factors for venous thromboembolism (VTE) in the peripartum period and to provide guidelines for risk assessment and thromboprophylactic measures for VTE in pregnant women. Guidelines for diagnostic testing and for acute and long term treatment of VTE are also provided.OPTIONS: specific subgroups of pregnant women are defined and appropriate prophylactic measures are outlined. OUTCOMES: venous thromboembolism remains a major cause of morbidity and mortality in pregnancy and the postpartum period. Identification of risk and adequate prophylaxis can decrease the incidence of VTE.EVIDENCE: evidence was gathered using Medline (National Library of Medicine) to identify relevant studies and from bibliographies of articles thus identified.RECOMMENDATIONS: although evidence is lacking to date from Grade I studies (properly controlled randomized studies) in pregnant patients, there is good evidence to support the role of prophylaxis in reducing the incidence of VTE in patients identified to be at risk in the non-pregnant population (II B). Based on risk assessment more patients should be considered for thromboprophylaxis, including women with a past history of a VTE and a known thrombophilia on long-term anticoagulation, women with a past history of a VTE, women with a known thrombophilia who have never experienced a VTE and potentially considered in women at the time of Caesarean section (II B; III C). The occurrence of VTE is effectively reduced by the use of low dose unfractionated heparin. Experience with low molecular weight heparin and pregnancy is building, but is limited at present. Unfractionated heparin remains the standard for the treatment of VTE in pregnancy at the present time. Following initial heparinization for the treatment of VTE, patients should be continued on anticoagulation throughout pregnancy and for six to 12 weeks postpartum or a total of three months of anticoagulation (II A).     

Incidence of thromboembolic complications in cesarean sections and heparin prophylaxis]

BACKGROUND AND AIM: Venous thromboembolism is a rare but severe complication of pregnancy and puerperium: it is the most frequent cause of death and maternal morbidity. Pregnancy leads to hemodynamic, hormonal and hematological changes which make hypercoagulability a secondary condition. In particular, surgical birth via an abdominal route is burdened with a higher risk of thromboembolic disease compared to spontaneous birth. The aim of this study was to highlight the increased incidence of deep venous thrombosis and pulmonary embolism after caesarean section. METHODS: All the pregnant women (no = 879) admitted to the institute from January 1997 to May 1998 were monitored: their clinical conditions were followed both during the last period of pregnancy and after birth in order to identify the onset of pre- and post-partum thromboembolic episodes. RESULTS: Among the women examined, 9 cases (1.02%) of lung embolism were observed, one of which was fatal. All 9 women had undergone caesarean section and in all cases the thromboembolic episode occurred between the second and fourth day after birth. Prophylactic therapy was not administered in any of the above cases. CONCLUSIONS: It is important that anti-thrombotic prophylaxis with heparin should be administered. Although this presents a number of collateral effects (hemorrhage, platelet deficiency, osteoporosis), it protects the woman from the risk of thromboembolic episodes, above all if a caesarean section is performed or if the personal and/or family medical history is positive for this pathology.     

Practice bulletin no. 123: thromboembolism in pregnancy

Pregnant women have a fourfold to fivefold increased risk of thromboembolism compared with nonpregnant women (1, 2). Approximately 80% of thromboembolic events in pregnancy are venous (3), with a prevalence of 0.5–2.0 per 1,000 pregnant women (4–9). Venous thromboembolism, including pulmonary embolism, accounts for 1.1 deaths per 100,000 deliveries (3), or 9 % of all maternal deaths in the United States (10). In the developing world, the leading cause of maternal death is hemorrhage (11); however, in developed nations, where hemorrhage is more often successfully treated and prevented, thromboembolic disease is one of the leading causes of death (12). The prevalence and severity of this condition during pregnancy and the peripartum period warrant special consideration of management and therapy. Such therapy includes the treatment of acute thrombotic events and prophylaxis for those at increased risk of thrombotic events. The purpose of this document is to provide information regarding the risk factors, diagnosis, management, and prevention of thromboembolism, particularly venous thromboembolism in pregnancy.     

A local risk score model for venous thromboembolism prophylaxis for caesarean section in Chinese women and comparison with international guidelines

ObjectiveRecommendations for venous thromboembolism (VTE) prophylaxis from authoritative guidelines for women undergoing caesarean delivery differed significantly and may not be applicable to Chinese populations. We aim to formulate a local risk model for VTE prophylaxis for caesarean section women.Material and methodsA local risk score model based on demographic, obstetric and medical parameters was used to assess the risk of VTE in women undergoing caesarean delivery from May 2017 to April 2018 in a regional obstetric unit. Women with increased risk (VTE Score ≥ 2) are given mechanical prophylaxis with pneumatic cuff and those with high risk (VTE Score ≥ 3) are additionally prescribed low molecular weight heparin (LMWH) as pharmacological prophylaxis in the early postpartum period. The risk scores obtained by applying other major guidelines were then compared.ResultsOf 859 patients were included for analysis, overweight (15.3%), advanced maternal age (9.7%), multiple pregnancy (5.1%), obesity (4.7%), and primary postpartum haemorrhage (4.1%) were the most common risk factors. Overall, 109 (12.7%) patients required mechanical prophylaxis and 28 (3.3%) patients required additional pharmacological prophylaxis. No patient had postpartum VTE events nor serious haemorrhage after receiving LMWH prophylaxis. In contrast, applying the Royal College of Obstetricians and Gynaecologists guidelines to our cohort, 649 (75.6%) patients would receive LMWH after caesarean section, compared with no patients under the American College of Obstetrics and Gynaecology guidelines.ConclusionsOur local risk score model avoided the need for large proportions of women to be subjected to pharmacological prophylaxis, and appeared safe and practical.     

妊娠相关静脉血栓栓塞症风险评估模型研究进展

妊娠相关静脉血栓栓塞症（pregnancy associated venous thromboembolism，PA-VTE）包括妊娠期和产褥期发生的静脉系统的血栓形成疾病，由深静脉血栓形成（deep vein thrombosis，DVT）和肺栓塞（pulmonary embolism，PE）组成的PA-VTE是发达国家孕产妇发病和死亡的主要原因。采用高效、便捷的风险评估模型评估PA-VTE的发病风险并进行分级预防是目前多个国家推荐的主要措施，但由于各国医学水平、经济发展和传统习惯的不同，各国相继开发风险评估模型或根据实际情况对其他国家的风险评估模型进行改良，进而对妊娠期及产褥期VTE风险进行个体化评估，并实施相应的血栓预防策略。通过回顾国内外的PA-VTE风险评估模型，旨在为我国进一步建立孕产妇的VTE防治指南提供依据，为产科医务工作者制定出适合我国产科人群的VTE风险评估模型提供参考。     

Venous thromboembolism during pregnancy and the post-partum period: incidence and risk factors in a large Victorian health service

BACKGROUND: There is a strong recommendation for post-partum thromboprophylaxis following emergency caesarean sections, particularly in overweight women, and following prolonged labour. AIMS: To analyse the incidence and epidemiological factors associated with antepartum and post-partum venous thromboembolism in a large Victorian health service. METHODS: A retrospective study of all 6987 women delivering at Ballarat Health Services between March 1999 and June 2006. Case notes of women with confirmed venous thromboembolism during this period were subjected to detailed analysis. The data were analysed for possible risk factors, the timing of thromboembolism in relation to the pregnancy and any correlation with thromboprophylaxis, if administered. Results: The rate of venous thromboembolism was 1.14 per 1000 deliveries, with risk factors of age > 30 (100%), obesity (75%), previous history of thromboembolism (62.5%) and caesarean section (37.5%). Majority of cases were diagnosed in first trimester (62.5%), and in the right lower limb (75%). None of the patients had been given thromboprophylaxis. CONCLUSION: While the incidence and risk factors were similar to those generally quoted, a much higher incidence was found in early pregnancy, and in the right lower limb. The importance of meticulous screening for risk factors in early pregnancy cannot be overemphasised.