| Venous thromboembolism in Pregnancy and Puerperium (VTE) is one of the life-threaten complications which is not uncommon in clinical practice. [1] This serious complication is hard to be observed and developing rapidly. Without early detection and positive effective treatment, the mortality could be quiet high. The VTE includes deep vein thrombosis (DVT) and pulmonary embolism (PE). According to the literature statistics, it shows that the probability of DVT, which constitute about 60%-80% of the VTE, [3] occurs in pregnant women is 4-5 times more than it in the non-pregnant. [2] Based on the fact that the maternal deaths caused by DVT contribute 9% to the total maternal mortality [4], it is particularly important to attach importance to the prevention, early diagnosis and timely treatment of VTE in Pregnancy and Puerperium. Classical approaches to cure deep vein thrombosis such as anticoagulation and surgical embolectomy are still widely used in clinical. In recent years, the development of catheter directed thrombolysis (CDT) has greatly improved the recanalization rates and decreased the incidence of Post-Thrombotic Syndrome (PTS), showing better clinical results. In this research, we try to analyze the clinical data of 42 patients with VTE in our hospital from January 2009 to January 2014, and review the treatment strategy.Objective:To investigate the Treatments Strategy of acute venous thromboembolism in Pregnancy and Puerperium.Methods:The clinical data of 42 patients with deep vein thrombosis in Pregnancy and Puerperium at the Third Affiliated Hospital of Guangzhou Medical College from January 2009 to January 2014 were analyzed retrospectively. Patients were divided into early Pregnancy and Puerperium, middle and late Pregnancy and Puerperium, puerperium. Corresponding treatments were carried on patients with different Pregnancy and Puerperium respectively:1) Early Pregnancy and Puerperium:raising the leg, anticoagulant therapy, and dynamic observation.2) Middle and late Pregnancy and Puerperium:raising the leg, anticoagulant therapy, dynamic observation, and cava filter placement for prevention of pulmonary embolism.3) Puerperium:raising the leg, anticoagulant therapy, cava filter placement for prevention of pulmonary embolism, and ultrasound guided popliteal vein catheter-directed thrombolysis (CDT).Dynamic acquisition of Doppler ultrasound and lower limb impedance volume chart was executed during treatment. The limb circumference was measured 15m below the knee and 25cm above the knee, as well as compared with the healthy side. Cases with no thrombus observed by ultrasound and limb circumference>1cm compared with the contralateral site were regarded as complete recanalization; others with ultrasound visible blood flow, the vessel blood flow> 70% of normal range, limb circumference> 2cm compared with the same part of the contralateral, were regarded as partial recanalization; and cases with limb swelling without relief and no blood flow observed by ultrasound were regarded as invalid.Collecting data were processed with SPSS13.0 statistical software package. Data between the groups were analyzed using Ridit analysis. Measurement data were expressed as mean ± standard deviation (x±s).Results:1) 37 cases (88.1%) were diagnosed by Doppler ultrasound, while five cases (11.9%) with venous thrombosis unobserved by Doppler ultrasound, were confirmed by MRI.2) 32 cases (76.2%) of thrombosis were in the left lower limb,9 case (21.4%) in the right, and 1 case (2.4%) in both limbs.33 cases (78.6%) of thrombosis were central one, three cases (9.5%) peripheral, and 5 cases (11.9%) mixed.3) Treatment:42 cases were treatment with low molecular weight heparin anticoagulant therapy,11 cases with cava filter placement, and 6 cases with catheterization thrombolysis. All patients were improved after treatment without fatal pulmonary embolism. The revascularization condition of patients with catheterization thrombolytic in 72h,3 months,6 months post procedure were statistically better than it with anticoagulation (P<0.05).Conclusion:Considering the high incident of venous thromboembolism and subsequent serious complications, it is necessary to choose the appropriate treatment depending on different circumstances during Pregnancy and Puerperium. Aggressive thrombolytic treatment on the basis of anticoagulation can prevent and reduce the complication occurrence, and consequently improve outcomes of VTE and reduce the morbidity of sequelae. |
