Cardiac Surgery and Obstetric Strategy for Thromboembolic Complications in Pregnant Women and Parturients

  • S. O. Siromakha National Amosov Institute of Cardiovascular Surgery, Kyiv, Ukraine; Bogomolets National Medical University, Kyiv, Ukraine
  • A. O. Rusnak National Amosov Institute of Cardiovascular Surgery, Kyiv, Ukraine
  • Yu. V. Davydova National Amosov Institute of Cardiovascular Surgery, Kyiv, Ukraine; Institute of Pediatrics, Obstetrics and Gynecology named after acad. O.M. Lukianova of NAMS of Ukraine, Kyiv, Ukraine
  • O. A. Mazur National Amosov Institute of Cardiovascular Surgery, Kyiv, Ukraine
  • N. P. Kuchkova National Amosov Institute of Cardiovascular Surgery, Kyiv, Ukraine
  • V. V. Lazoryshynets National Amosov Institute of Cardiovascular Surgery, Kyiv, Ukraine
Keywords: venous thromboembolism, pregnancy, cardiac surgery

Abstract

Venous thromboembolism (VTE), and specifically its manifestation – pulmonary embolism (PE) – is the most common direct cause of maternal mortality in the world and ranks 3-4th among the causes of maternal mortality in Ukraine. The multidisciplinary team (pregnancy heart team) established at two academic institutions in 2013, presents its experience of treating VTE in pregnant women and parturients, as well as analysis of common pitfalls of medical care for pregnant women with VTE. The group of pregnant women (parturients) with VTE consisted of 8 patients, 6 of whom were pregnant, 2 were parturients. In 2 pregnant women and 2 parturients with high-risk PE, 4 surgical procedures were performed (three open-heart surgeries – thromboectomy from pulmonary artery, one endovascular inferior vena cava filter implantation), including a pregnant woman (24–25 week) with a massive high-risk PE who underwent an urgent surgery – pulmonary artery thrombectomy and a tricuspid valve repair (with fetus in utero) with prolongation of pregnancy to 39 weeks and the birth of a healthy baby. One perinatal twin loss was observed in patient after extracorporeal fertilization and acute VTE.

The main causes of the VTE are the underestimation of risk factors in preconceptional counseling, and the lack of pre-gravid preparation of women, as well as the prevention of the development of venous thrombosis in ante-, intra- and postnatal periods. The diagnosis of VTE and PE in time, and competent medical support provided for such women during pregnancy is a key to minimizing cardiovascular risks and reducing maternal mortality rates.

The National Pregnancy Heart Team presents algorithms for primary and secondary prevention and treatment of VTE.

References

  1. Conti E, Zezza L, Ralli E, Comito C, Sada L, Passerini J, et al. Pulmonary embolism in pregnancy. J. Thromb. Thrombolysis. 2014;37:251–70. https://doi.org/10.1007/s11239-013-0941-9
  2. Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41(4):543–603. https://doi.org/10.1093/eurheartj/ehz405
  3. Pick J, Berlin D, Horowitz J, Winokur R, Sista AK, Lichtman AD. Massive pulmonary embolism in pregnancy treated with catheter‐directed tissue plasminogen activator. A A Case Rep. 2015;4:91–4. https://doi.org/10.1213/XAA.0000000000000128
  4. Tawfik MM, Taman ME, Motawea AA, Abdel-Hady E. Thrombolysis for the management of massive pulmonary embolism in pregnancy. Int. J. Obstet. Anesth. 2013;22:149–52. https://doi.org/10.1016/j.ijoa.2012.12.010
  5. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, Cífková R, De Bonis M, et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018 Sep 7;39(34):3165–241. https://doi.org/10.1093/eurheartj/ehy340.
  6. Wells PS, Anderson DR, Rodger M, Stiell I, Dreyer JF, Barnes D, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med. 2001 Jul 17;135(2):98–107. https://doi.org/10.7326/0003-4819-135-2-200107170-00010
  7. Schoenbeck D, Nicolle A, Newbegin K, Hanley J, Loughney AD. The Use of a Scoring System to Guide Thromboprophylaxis in a High-Risk Pregnant Population. Thrombosis. 2011;2011:652796. https://doi.org/10.1155/2011/652796
  8. Davydova YuV, Ogorodnyk AO. [Prevention of thromboembolic disorders during pregnancy and the Puerperium]. Zdorovia Ukrainy. 2016;2(22):11–3. Ukrainian.
  9. Royal College of Obstetricians and Gynaecologists. Reducing the Risk of Venous Thromboembolism during Pregnancy and the Puerperium. Green-top Guideline. 37a; 2015.
Published
2020-03-24
How to Cite
Siromakha, S. O., Rusnak, A. O., Davydova, Y. V., Mazur, O. A., Kuchkova, N. P., & Lazoryshynets, V. V. (2020). Cardiac Surgery and Obstetric Strategy for Thromboembolic Complications in Pregnant Women and Parturients. Ukrainian Journal of Cardiovascular Surgery, (1 (38), 69-74. https://doi.org/10.30702/ujcvs/20.3803/010069-074
Section
GENERAL ISSUES OF TREATMENT OF PATIENTS WITH CARDIOVASCULAR PATHOLOGY

Most read articles by the same author(s)