DÄ internationalArchive7/2017Risk Increased During Pregnancy
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The risk for developing venous thromboembolism (VTE) is 4–5 times higher during pregnancy. In 80% of cases, this will manifest as deep vein thrombosis of the leg and in 20% as pulmonary embolism (1, 2). VTE is responsible for 20% of deaths associated with pregnancy.

During the postpartum period, the risk of VTE is increased by a factor of 20; one case-control study even showed an increase by a factor of 60 (1). This risk, which persists for two weeks, is highest in the first week postpartum. Since in outpatient births, new mothers leave the hospital on the same day or the day after, increasing numbers of cases of VTE occur outside obstetric wards. For this reason, practices and hospitals jointly carry responsibility for prevention. The risk profile may change during the course of the pregnancy, and this will need to be communicated accordingly. Examples include more severe peripartum or postpartum hemorrhages.

The most important risk factor is prior VTE, with a risk of recurrence of a factor of 25 in persons without thrombophilia. It is not realistic to expect that this might be routinely tested for in a laboratory. But considering the question of Factor V-Leiden mutation is worthwhile, as the homozygotic form is associated with a 35 times higher risk.

These considerations are also relevant in view of a scenario of a rate of cesarean section of 30%; consequently, immobilization in the initial days after the birth will be much more common than after vaginal delivery. Stringent early mobilization and more instruction regarding independent exercises are required, as called for by the authors (3). In spite of a lack of staff in obstetric wards, drug prophylaxis should not gain greater importance than physical prophylaxis.

VTE incidence rates between 0.5 and 1.7 per 1000 births—a difference by a factor of 3 (4)—indicate a clear need for improvement.

DOI: 10.3238/arztebl.2017.0118a

Prof. Dr. med. J. Matthias Wenderlein

Universität Ulm

wenderlein@gmx.de

Conflict of interest statement

The author declares that no conflict of interest exists.

1.
Heit JA, Kobbervig CE, James AH, et al.: Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Intern Med 2005; 143: 697–706 CrossRef MEDLINE
2.
Pomp ER, Lenselink AM, Rosendaal FR, Doggen CJ: Pregnancy, the postpartum period and prothrombotic defects: risk of venous thrombosis in the MEGA study. J Thromb Haemost 2008; 6: 632–37 CrossRef MEDLINE
3.
Encke A, Haas S, Kopp I: Clinical practice guideline: The prophylaxis
of venous thromboembolism. Dtsch Arztebl Int 2016; 113: 532–8 VOLLTEXT
4.
James A: Venous thromboembolism in pregnancy. Arterioscler Thromb Vasc Biol 2009; 29: 326–31 CrossRef MEDLINE
1.Heit JA, Kobbervig CE, James AH, et al.: Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Intern Med 2005; 143: 697–706 CrossRef MEDLINE
2.Pomp ER, Lenselink AM, Rosendaal FR, Doggen CJ: Pregnancy, the postpartum period and prothrombotic defects: risk of venous thrombosis in the MEGA study. J Thromb Haemost 2008; 6: 632–37 CrossRef MEDLINE
3.Encke A, Haas S, Kopp I: Clinical practice guideline: The prophylaxis
of venous thromboembolism. Dtsch Arztebl Int 2016; 113: 532–8 VOLLTEXT
4.James A: Venous thromboembolism in pregnancy. Arterioscler Thromb Vasc Biol 2009; 29: 326–31 CrossRef MEDLINE

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