Maternal pulmonary embolia during pregnancy and puerperium

B. Riga, E. D. Campos, M. Widode, K. Fade

Abstract: Pulmonary embolia during pregnancy and post partum represent one of the causes of maternal mortality during this period. It is estimated that the risk of thromboembolic disease during pregnancy is 1 : 1000 to 1 : 2000 pregnancies. This is explained by the changes in the physiology and biology of coagulation factors and fibrinolysis. The risk is increased in women aged more than 35, the presence of a past history of thromboembolic disease, hereditary or acquired thrombophilia or delivery by caesarean section. The diagnosis should be confirmed with the same rigor as outside pregnancy. No diagnostic examination is contraindicated in those pregnant, but the diagnostic strategy should be in favor of non-invasive examinations with ultrasonic venography of the lower limbs and/or pulmonary scintigraphy being the investigations of choice. The treatment of pulmonary embolia during pregnancy rests on heparin, coumarin being strictly contraindicated due to the risk of fetal malformation. Low molecular weight heparin is not currently used during pregnancy but initial data in the literature suggests that they may be used during pregnancy without increased risk compared to non-fractionated heparin. The indications for anticoagulant prophylaxis remains poorly characterized.
Keywords: Pulmonary emboli, Pregnancy, Venous thrombosis,Thrombophilia