Thrombose und Schwangerschaft

 

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Zusammenfassung

Eine TBVT in der Schwangerschaft geht mit erheblichen Risiken für Mutter und Kind einher. Jeder Verdacht bedarf deshalb einer sofortigen und eindeutigen Abklärung unter Berücksichtigung der Risiken für das ungeborene Kind durch die Diagnostik. Die Klinik ist häufig unspezifisch und erprobte Diagnosealgorithmen fehlen für schwangere Patientinnen.

Die Diagnostik erfolgt apparativ mittels Kompressionssonografie der proximalen und distalen Venen.

Für die Abklärung einer iliakalen Thrombose steht neben der Duplexsonografie die MR-Phlebografie zur Verfügung. Diese sollte jedoch nur bei zwingender Notwendigkeit zum Einsatz kommen. Die Behandlung der Venenthrombose erfolgt in der Regel mit einem niedermolekularen Heparin (NMH) in therapeutischer Dosisierung. Danaparoid oder Fondaparinux sind bei Heparin-induzierter Thrombozythämie als Ausweichpräparat indiziert, Fondaparinux weist hierbei eine deutlich einfachere Handhabung auf. In der Stillperiode können die Medikamente Warfarin bzw. NMH angewandt werden.

Die gerinnungshemmende Therapie wird bei einer Thrombose bis mindestens 6 Wochen postpartal und insgesamt über einen Zeitraum von mindestens 3 Monaten, je nach Lokalisation, fortgeführt.

Abstract

Deep vein thrombosis in pregnancy is a considerable risk for mother and child. In case of suspected thrombosis instant distinct diagnosis is needed considering the risk for the unborn child through medical diagnostics. Symptoms are often nonspecific and there is no approved algorithm for the diagnosis of vein thrombosis in pregnancy.

Diagnostic analysis is done by duplex sonography with compression of the proximal and distal veins.

When an iliac thrombosis is suspected MR-Phlebography can be useful in addition to duplex sonography, but should only be used in urgent cases.

For the treatment of vein thrombosis low molecular heparin in therapeutic dosage is used usually. Danaparoid and Fondaparinux are indicated in patients with heparin-induced thrombocytopenia. In the nursing period low molecular heparin or warfarin can be applied.

Antikoagulant therapy for deep vein thrombosis should be continued for at least 6 weeks after birth, but at least 3 month in total depending on localization.

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