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Z Geburtshilfe Neonatol 2007; 211(1): 1-7
DOI: 10.1055/s-2006-942222
Übersicht

© Georg Thieme Verlag Stuttgart · New York

Thromboembolische Erkrankungen in der Schwangerschaft

Thromboembolic Diseases in PregnancyO. N. Richter1 , W. Rath1
  • 1Universitätsklinikum Aachen, Klinik für Gynäkologie und Geburtshilfe, Aachen
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Publication History

2006

2006

Publication Date:
27 February 2007 (online)

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Zusammenfassung

In der Schwangerschaft treten thromboembolische Komplikationen sechsmal häufiger auf als bei nichtschwangeren Frauen. Die wesentlichen Faktoren für ein erhöhtes Thrombose- und Lungenembolie-Risiko sind Alter, idiopathische wie sekundäre Thrombosen in der Anamnese, Entbindungsmodus, Immobilisierung und / oder Fettleibigkeit sowie die thrombophilen Hämostasestörungen. Als Thromboseprophylaxe sind die niedermolekularen Heparine (NMHs) gegenüber den unfraktionierten Heparinen (UFHs) Mittel der ersten Wahl. Orale Antikoagulantien wie die Cumarinderivate und die Thrombozytenaggregationshemmer sind angesichts einer ganzen Reihe von Kontraindikationen von untergeordneter Bedeutung. Der Ausschluss einer tiefen Beinvenenthrombose (TVT) und / oder einer Lungenembolie in der Schwangerschaft folgt den üblichen Diagnosealgorithmen unter Berücksichtigung einer möglichst geringen Strahlenbelastung durch eventuell erforderliche apparative Diagnostik. Bei der Therapie nachgewiesener TVTs sind die UFHs zu favorisieren, es bestehen mittlerweile aber auch zunehmend gute Erfahrungen bei der Anwendung der NMHs. Erweist sich eine Heparintherapie als nicht ausreichend oder droht die Gefahr eines postthrombotischen Syndroms, so ist in bestimmten Fällen der zusätzliche Einsatz einer Lysetherapie und / oder einer operativen Thrombektomie zu erwägen.

Abstract

In pregnancy, thromboembolic complications are six times more frequent than in nonpregnant women. Maternal age, idiopathic or secondary thrombosis in the patients history, the mode of delivery, bed rest and / or obesity as well as the thrombophilic defects are considerable factors for an increased risk of deep vein thrombosis (DVT) and pulmonary embolism (PE). Compared to unfractionated heparins (UFHs) prophylactic treatment relies mainly on low molecular weight heparins (LMWHs) which safety is now well established in pregnant women. In view of their multiple side effects oral anticoagulants such as cumarine or aspirine are contraindicated or of subordinate importance. The procedures to exclude DVT follow the usual diagnostic algorithms considering maximum radiation protection in case of further apparative diagnostics. Although there are reported good experiences with LMWHs in the treatment of DVT, UFHs are still the prefered drugs in this clinical condition. Insufficient heparin treatment or impending postthrombotic complications may be reasons for additional therapies like thrombolysis or operative thrombectomy.

Schlüsselwörter

Schwangerschaft - thrombophile Hämostasestörungen - Thromboseprophylaxe - Thromboembolie - Heparin

Key words

pregnancy - thrombophilic defects - thromboprophylaxis - thromboembolia - heparin

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