[cactus1972]

Опубликованы рекомендации ACOG по профилактике тромбоэмболических осложнений у беременных.
Основные положения гайдлайна:

Compared with nonpregnant women, pregnant women have a 4-fold to 5-fold increased risk for thromboembolism. About 80% of thromboembolic events during pregnancy are venous, with pulmonary embolism and other VTE responsible for 1.1 deaths per 100,000 deliveries, or 9% of all maternal deaths in the United States.

The only specific Level A ACOG recommendation (based on good and consistent scientific evidence) is that compression ultrasonography of the proximal veins is the recommended initial diagnostic test when signs or symptoms suggest new onset deep vein thrombosis.

Level B ACOG recommendations and conclusions (based on limited or inconsistent scientific evidence) include the following:
•Heparin compounds are the preferred anticoagulants in pregnancy.
•To minimize postpartum bleeding complications, a reasonable strategy is to resume anticoagulation therapy no sooner than 4 to 6 hours after vaginal delivery, or 6 to 12 hours after cesarean delivery.
•Warfarin, low molecular weight heparin (LMWH), and unfractionated heparin are compatible with breast-feeding because they do not accumulate in breast milk and do not lead to anticoagulation in the infant.

Level C ACOG recommendations (based primarily on consensus and expert opinion) include the following:
•Women with a history of thrombosis who have not been thoroughly evaluated for possible underlying causes should receive testing for antiphospholipid antibodies, as well as for inherited thrombophilias.
•For women with acute thromboembolism during the current pregnancy, or for those at high risk for VTE, including women with mechanical heart valves, therapeutic anticoagulation is recommended.
•For women in whom restarting anticoagulation is planned after delivery, pneumatic compression devices should be left in place until the woman is ambulatory and anticoagulation therapy is resumed.
•In the last month of pregnancy, or sooner if delivery appears imminent, women receiving either therapeutic or prophylactic anticoagulation may be converted from LMWH to unfractionated heparin, which has a shorter half-life.
•Neuraxial blockade should be withheld for 10 to 12 hours after the last prophylactic dose of LMWH, or 24 hours after the last therapeutic dose of LMWH.
•For all women not already receiving thromboprophylaxis, placement of pneumatic compression devices before cesarean delivery is recommended. However, an emergency cesarean delivery should not be delayed for the placement of compression devices.
Cesarean delivery is an independent risk factor for thromboembolic events — it nearly doubles a woman's risk. "Fitting inflatable compression devices on a woman's legs before cesarean delivery is a safe, potentially cost-effective preventive intervention. Inflatable compression sleeves should be left in place until a woman is able to walk after delivery or — in women who had been on blood thinners during pregnancy — until anticoagulation medication is resumed."

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