産科領域における静脈血栓塞栓症の臨床的検討(<特集>第57回シンポジウム: 肺塞栓-その予防と治療-)
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概要
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Since 2001, all patients undergoing cesarean section have been required to wear elastic stockings before surgery and use an intermittent pneumatic compression (IPC) device after surgery with the aim of preventing perioperative pulmonary thromboembolism (PTE). In 2001-2003, cesarean section was performed in a total of 1,064 patients and postoperative PTE was diagnosed in nine of them (0.85%). From 1985 to 2003, 17 pregnant women were diagnosed with venous thromboembolism (VTE). We also investigated the changes of D-dimer during normal pregnancy. Based on the findings obtained in these subjects, it was concluded that the occurrence of PTE after cesarean section is not completely preventable by the above measures, and that early diagnosis and treatment of PTE are as important as prevention. Detection of decreasing SpO_2 levels by pulse oximetry was found to be useful for the early diagnosis of PTE. Because it is difficult to detect blood clots at some locations by imaging, PTE should be diagnosed by comprehensively assessing the results of coagulation-fibrinolysis tests and clinical findings. The incidence of VTE was the highest during early pregnancy, as well as weeks 20-30 of pregnancy. Adequate anticoagulant therapy was provided before delivery in many patients, so few patients needed the prepartum insertion of an IVC filter. In normal pregnant women, D-dimer levels during the 1st trimester were comparable with those in nonpregnant women and increased gradually during and after the 2nd trimester. D-dimer was found to be useful for evaluation of the response to therapy and course in obstetric medicine and may also be useful for screening during early pregnancy.
- 2005-09-01
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