a.血栓・塞栓症(5.その他)

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The incidence of pulmonary embolism (PE) occurring in either puerperium or postoperative course has become so higher in recent years that the way of prevention, diagnosis and treatment of PE should be reviewed. The high-risk patients for precedent deep venous embolism (DVT) include pregnancy itself and intra pelvic operation as well as the patients with antiphosphoiolipid antibody, congenital deficiency of protein S and C and antithrombin III. DVT is abrupt in onset with severe pain and edema, mainly on the left leg. In this occasion, venography and ultrasonography with color Doppler are useful for the diagnosis of DVT. In addition to this, the usefulness of MRI has been revealed. On the other hand, the most common symptoms of PE are dyspnea, chest pain, coughm, shock, and hemoptosis, of which the diagnosis is required to be prompt and accurte, since the commencement of treatment is mandatory for the successful outcome. In general, ventilation-perfusion scintigraphy is used for diagnosis of PE. The method of treatment for DVT and PE is basically consisting of anticoagulaltion and fibrinolytic therapy. ACOG has recommended low molecular heparin as well as regular heparin therapy and either urokinase or tPA is used as fibrinolytic therapy. The pathogenesis of thromboembolic diseases recommended us to take the preventive measures for DVD and PE, such as the pneumocompression of lower extremities during surgery or post surgical state, administration of prophylactic heparin or vena cava filter. All patients with a gynecological disease and pregnant women have risks for PE and DVT. Therefore, all obstetricians and gynecologist must understand the mechanisms and managements of PE and DVT.
社団法人日本産科婦人科学会の論文
2002-08-01

a.血栓・塞栓症(5.その他)

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