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Management of Acute Pulmonary Embolism pp 213–233Cite as

Pulmonary Embolism in Pregnancy

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Part of the book series: Contemporary Cardiology ((CONCARD))

Abstract

Pregnancy is associated with a 5- to 10-fold increase in the incidence of venous thromboembolism. Pulmonary embolism (PE) remains a leading cause of maternal mortality in developed countries. The diagnosis, treatment, and prevention of PE during pregnancy continue to present a challenge to healthcare professionals. Many commonly used diagnostic tests are less accurate in pregnant than in nonpregnant patients, and some radiological procedures expose the fetus to ionizing radiation. There are limited data regarding the efficacy of anticoagulant therapy in the treatment and prophylaxis of PE during pregnancy. The treatment of PE in pregnant women is also made more difficult because warfarin can cause embryopathy and other adverse fetal effects, and unfractionated heparin and low-molecular-weight heparins, the cornerstones of therapy in this patient population, may have maternal side effects. This chapter reviews areas of controversy and provides recommendations for the diagnostic workup and treatment of PE, as well as thromboprophylaxis, in pregnant women.

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References

  1. Weindling AM. The confidential enquiry into maternal and child health (CEMACH). Arch Dis Child 2003;88:1034–1037.

    PubMed  CAS  Google Scholar 

  2. Confidential Enquiry into Maternal and Child Health. Why Mothers Die 2000–2002: The Sixth Report of the Confidential Enquiries into Maternal Death in the United Kingdom. RCOG Press, London, 2004.

    Google Scholar 

  3. Franks AL, Atrash HK, Lawson HW, Colberg KS. Obstetrical pulmonary embolism mortality, United States, 1970–85. Am J Public Health 1990;80:720–722.

    PubMed  CAS  Google Scholar 

  4. Atrash HK, Koonin LM, Lawson HW, et al. Maternal mortality in the United States, 1979–1986. Obstet Gynecol 1990;76:1055–1060.

    PubMed  CAS  Google Scholar 

  5. Berg CJ, Atrash HK, Koonin LM, Tucker M. Pregnancy-related mortality in the United States, 1987–1990. Obstet Gynecol 1996;88:161–167.

    PubMed  CAS  Google Scholar 

  6. Chang J, Elam-Evans LD, Berg CJ, et al. Pregnancy-related mortality surveillance-United States, 1991–1999. MMWR Surveill Summ 2003;52:1–8.

    PubMed  Google Scholar 

  7. Greer IA. Thrombosis in pregnancy: maternal and fetal issues. Lancet 1999;353:1258–1265.

    PubMed  CAS  Google Scholar 

  8. Anderson FA Jr, Wheeler HB, Goldberg RJ, et al. A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT Study. Arch Intern Med 1991;151:933–938.

    PubMed  Google Scholar 

  9. Nordstrom M, Lindblad B, Bergqvist D, Kjellstrom T. A prospective study of the incidence of deepvein thrombosis within a defined urban population. J Intern Med 1992;232:155–160.

    PubMed  CAS  Google Scholar 

  10. Samuelsson E, Hagg S. Incidence of venous thromboembolism in young Swedish women and possibly preventable cases among combined oral contraceptive users. Acta Obstet Gynecol Scand 2004;83:674–681.

    PubMed  Google Scholar 

  11. Aaro LA, Johnson TR, Juergens JL. Acute deep venous thrombosis associated with pregnancy. Obstet Gynecol 1966;28:553–558.

    PubMed  CAS  Google Scholar 

  12. Solomons E. Puerperal thrombophlebitis: prevention and treatment. Postgrad Med 1963;34:105–111.

    PubMed  CAS  Google Scholar 

  13. Treffers PE, Huidekoper BL, Weenink GH, Kloosterman GJ. Epidemiological observations of thromboembolic disease during pregnancy and in the puerperium, in 56,022 women. Int J Gynaecol Obstet 1983;21:327–331.

    PubMed  CAS  Google Scholar 

  14. Hull RD, Raskob GE, Carter CJ. Serial impedance plethysmography in pregnant patients with clinically suspected deep-vein thrombosis. Clinical validity of negative findings. Ann Intern Med 1990;112:663–667.

    PubMed  CAS  Google Scholar 

  15. Chan WS, Ray JG, Murray S, et al. Suspected pulmonary embolism in pregnancy: clinical presentation, results of lung scanning, and subsequent maternal and pediatric outcomes. Arch Intern Med 2002;162:1170–1175.

    PubMed  CAS  Google Scholar 

  16. Macklon NS, Greer IA. Venous thromboembolic disease in obstetrics and gynaecology: the Scottish experience. Scott Med J 1996;41:83–86.

    PubMed  CAS  Google Scholar 

  17. Lindqvist P, Dahlback B, Marsal K. Thrombotic risk during pregnancy: a population study. Obstet Gynecol 1999;94:595–599.

    PubMed  CAS  Google Scholar 

  18. Andersen BS, Steffensen FH, Sorensen HT, et al. The cumulative incidence of venous thromboembolism during pregnancy and puerperium—an 11 year Danish population-based study of 63,300 pregnancies. Acta Obstet Gynecol Scand 1998;77:170–173.

    PubMed  CAS  Google Scholar 

  19. McColl MD, Ramsay JE, Tait RC, et al. Risk factors for pregnancy associated venous thromboembolism. Thromb Haemost 1997;78:1183–1188.

    PubMed  CAS  Google Scholar 

  20. Gherman RB, Goodwin TM, Leung B, et al. Incidence, clinical characteristics, and timing of objectively diagnosed venous thromboembolism during pregnancy. Obstet Gynecol 1999;94:730–734.

    PubMed  CAS  Google Scholar 

  21. Simpson EL, Lawrenson RA, Nightingale AL, Farmer RD. Venous thromboembolism in pregnancy and the puerperium: incidence and additional risk factors from a London perinatal database. BJOG 2001;108:56–60.

    PubMed  CAS  Google Scholar 

  22. White RH. The epidemiology of venous thromboembolism. Circulation 2003;107:14–18.

    Google Scholar 

  23. Huisman MV, Buller HR, ten Cate JW, et al. Unexpected high prevalence of silent pulmonary embolism in patients with deep venous thrombosis. Chest 1989;95:498–502.

    PubMed  CAS  Google Scholar 

  24. Ray JG, Chan WS. Deep vein thrombosis during pregnancy and the puerperium: a meta-analysis of the period of risk and the leg of presentation. Obstet Gynecol Surv 1999;54:265–271.

    PubMed  CAS  Google Scholar 

  25. Stein PD, Hull RD, Kayali F, et al. Venous thromboembolism in pregnancy: 21-year trends. Am J Med 2004;117:121–125.

    PubMed  Google Scholar 

  26. Danilenko-Dixon DR, Heit JA, Silverstein MD, et al. Risk factors for deep vein thrombosis and pulmonary embolism during pregnancy or post partum: a population-based, case-control study. Am J Obstet Gynecol 2001;184:104–110.

    PubMed  CAS  Google Scholar 

  27. Bergqvist A, Bergqvist D, Hallbook T. Deep vein thrombosis during pregnancy. A prospective study. Acta Obstet Gynecol Scand 1983;62:443–448.

    PubMed  CAS  Google Scholar 

  28. Rosendaal FR. Venous thrombosis: a multicausal disease. Lancet 1999;353:1167–1173.

    PubMed  CAS  Google Scholar 

  29. Hellgren M. Hemostasis during normal pregnancy and puerperium. Semin Thromb Hemost 2003;29:125–130.

    PubMed  CAS  Google Scholar 

  30. Cerneca F, Ricci G, Simeone R, et al. Coagulation and fibrinolysis changes in normal pregnancy. Increased levels of procoagulants and reduced levels of inhibitors during pregnancy induce a hypercoagulable state, combined with a reactive fibrinolysis. Eur J Obstet Gynecol Reprod Biol 1997;73:31–36.

    PubMed  CAS  Google Scholar 

  31. Clark P, Brennand J, Conkie JA, et al. Activated protein C sensitivity, protein C, protein S and coagulation in normal pregnancy. Thromb Haemost 1998;79:1166–1170.

    PubMed  CAS  Google Scholar 

  32. Comp PC, Thurnau GR, Welsh J, Esmon CT. Functional and immunologic protein S levels are decreased during pregnancy. Blood 1986;68:881–885.

    PubMed  CAS  Google Scholar 

  33. Wright JG, Cooper P, Astedt B, et al. Fibrinolysis during normal human pregnancy: complex interrelationships between plasma levels of tissue plasminogen activator and inhibitors and the euglobulin clot lysis time. Br J Haematol 1988;69:253–258.

    PubMed  CAS  Google Scholar 

  34. Kruithof EK, Tran-Thang C, Gudinchet A, et al. Fibrinolysis in pregnancy: a study of plasminogen activator inhibitors. Blood 1987;69:460–466.

    PubMed  CAS  Google Scholar 

  35. Kerr MG, Scott DB, Samuel E. Studies of the inferior vena cava in late pregnancy. Br Med J 1964;5382:532–533.

    Google Scholar 

  36. Ginsberg JS, Brill-Edwards P, Burrows RF, et al. Venous thrombosis during pregnancy: leg and trimester of presentation. Thromb Haemost 1992;67:519–520.

    PubMed  CAS  Google Scholar 

  37. Stewart GJ, Lachman JW, Alburger PD, et al. Venodilation and development of deep vein thrombosis in total hip and knee replacement patients. Thromb Haemost 1987;58:242–245.

    Google Scholar 

  38. Hellgren M, Tengborn L, Abildgaard U. Pregnancy in women with congenital antithrombin III deficiency: experience of treatment with heparin and antithrombin. Gynecol Obstet Invest 1982;14:127–141.

    PubMed  CAS  Google Scholar 

  39. Conard J, Horellou MH, Van Dreden P, et al. Thrombosis and pregnancy in congenital deficiencies in AT III, protein C or protein S: study of 78 women. Thromb Haemost 1990;63:319–320.

    PubMed  CAS  Google Scholar 

  40. De Stefano V, Leone G, Mastrangelo S, et al. Thrombosis during pregnancy and surgery in patients with congenital deficiency of antithrombin III, protein C, protein S. Thromb Haemost 1994;71:799–800.

    PubMed  Google Scholar 

  41. Pabinger I, Schneider B. Thrombotic risk in hereditary antithrombin III, protein C, or protein S deficiency. A cooperative, retrospective study. Gesellschaft fur Thrombose-und Hamostaseforschung (GTH) Study Group on Natural Inhibitors. Arterioscler Thromb Vasc Biol 1996;16:742–748.

    PubMed  CAS  Google Scholar 

  42. Friederich PW, Sanson BJ, Simioni P, et al. Frequency of pregnancy-related venous thromboembolism in anticoagulant factor-deficient women: implications for prophylaxis. Ann Intern Med 1996;125:955–960.

    PubMed  CAS  Google Scholar 

  43. van Boven HH, Vandenbroucke JP, Briet E, Rosendaal FR. Gene-gene and gene-environment interactions determine risk of thrombosis in families with inherited antithrombin deficiency. Blood 1999;94:2590–2594.

    PubMed  Google Scholar 

  44. Martinelli I, De Stefano V, Taioli E, et al. Inherited thrombophilia and first venous thromboembolism during pregnancy and puerperium. Thromb Haemost 2002;87:791–795.

    PubMed  CAS  Google Scholar 

  45. McColl MD, Ellison J, Reid F, et al. Prothrombin 20210 G→A, MTHFR C677T mutations in women with venous thromboembolism associated with pregnancy. BJOG 2000;107:565–569.

    PubMed  CAS  Google Scholar 

  46. Greer IA. Inherited thrombophilia and venous thromboembolism. Best Pract Res Clin Obstet Gynaecol 2003;17:413–425.

    PubMed  Google Scholar 

  47. Gerhardt A, Scharf RE, Beckmann MW, et al. Prothrombin and factor V mutations in women with a history of thrombosis during pregnancy and the puerperium. N Engl J Med 2000;342:374–380.

    PubMed  CAS  Google Scholar 

  48. Hellgren M, Svensson PJ, Dahlback B. Resistance to activated protein C as a basis for venous thromboembolism associated with pregnancy and oral contraceptives. Am J Obstet Gynecol 1995;173:210–213.

    PubMed  CAS  Google Scholar 

  49. Hirsch DR, Mikkola KM, Marks PW, et al. Pulmonary embolism and deep venous thrombosis during pregnancy or oral contraceptive use: prevalence of factor V Leiden. Am Heart J 1996;131:1145–1148.

    PubMed  CAS  Google Scholar 

  50. Bokarewa MI, Bremme K, Blomback M. Arg506-Gln mutation in factor V and risk of thrombosis during pregnancy. Br J Haematol 1996;92:473–478.

    PubMed  CAS  Google Scholar 

  51. Hallak M, Senderowicz J, Cassel A, et al. Activated protein C resistance (factor V Leiden) associated with thrombosis in pregnancy. Am J Obstet Gynecol 1997;176:889–893.

    PubMed  CAS  Google Scholar 

  52. Grandone E, Margaglione M, Colaizzo D, et al. Genetic susceptibility to pregnancy-related venous thromboembolism: roles of factor V Leiden, prothrombin G20210A, and methylenetetrahydrofolate reductase C677T mutations. Am J Obstet Gynecol 1998;179:1324–1328.

    PubMed  CAS  Google Scholar 

  53. Yilmazer M, Kurtay G, Sonmezer M, Akar N. Factor V Leiden and prothrombin 20210 G-A mutations in controls and in patients with thromboembolic events during pregnancy or the puerperium. Arch Gynecol Obstet 2003;268:304–308.

    PubMed  CAS  Google Scholar 

  54. Lensen RP, Bertina RM, de Ronde H, et al. Venous thrombotic risk in family members of unselected individuals with factor V Leiden. Thromb Haemost 2000;83:817–821.

    PubMed  CAS  Google Scholar 

  55. Middeldorp S, Henkens CM, Koopman MM, et al. The incidence of venous thromboembolism in family members of patients with factor V Leiden mutation and venous thrombosis. Ann Intern Med 1998;128:15–20.

    PubMed  CAS  Google Scholar 

  56. Tormene D, Simioni P, Prandoni P, et al. Factor V Leiden mutation and the risk of venous thromboembolism in pregnant women. Haematologica 2001;86:1305–1309.

    PubMed  CAS  Google Scholar 

  57. Simioni P, Sanson BJ, Prandoni P, et al. Incidence of venous thromboembolism in families with inherited thrombophilia. Thromb Haemost 1999;81:198–202.

    PubMed  CAS  Google Scholar 

  58. Middeldorp S, Meinardi JR, Koopman MM, et al. A prospective study of asymptomatic carriers of the factor V Leiden mutation to determine the incidence of venous thromboembolism. Ann Intern Med 2001;135:322–327.

    PubMed  CAS  Google Scholar 

  59. Simioni P, Tormene D, Prandoni P, et al. Incidence of venous thromboembolism in asymptomatic family members who are carriers of factor V Leiden: a prospective cohort study. Blood 2002;99:1938–1942.

    PubMed  CAS  Google Scholar 

  60. Murphy RP, Donoghue C, Nallen RJ, et al. Prospective evaluation of the risk conferred by factor V Leiden and thermolabile methylenetetrahydrofolate reductase polymorphisms in pregnancy. Arterioscler Thromb Vasc Biol 2000;20:266–270.

    PubMed  CAS  Google Scholar 

  61. Martinelli I, Legnani C, Bucciarelli P, et al. Risk of pregnancy-related venous thrombosis in carriers of severe inherited thrombophilia. Thromb Haemost 2001;86:800–803.

    PubMed  CAS  Google Scholar 

  62. Middeldorp S, Libourel EJ, Hamulyak K, et al. The risk of pregnancy-related venous thromboembolism in women who are homozygous for factor V Leiden. Br J Haematol 2001;113:553–555.

    PubMed  CAS  Google Scholar 

  63. The Procare Group. Risk of venous thromboembolism during pregnancy in homozygous carriers of the factor V Leiden mutation: are there any predictive factors? J Thromb Haemost 2004;2:359–360.

    Google Scholar 

  64. Lindqvist PG, Svensson PJ, Marsaal K, et al. Activated protein C resistance (FV:Q506) and pregnancy. Thromb Haemost 1999;81:532–537.

    PubMed  CAS  Google Scholar 

  65. Emmerich J, Rosendaal FR, Cattaneo M, et al. Combined effect of factor V Leiden and prothrombin 20210A on the risk of venous thromboembolism—pooled analysis of 8 case-control studies including 2310 cases and 3204 controls. Study Group for Pooled-Analysis in Venous Thromboembolism. Thromb Haemost 2001;86:809–816.

    PubMed  CAS  Google Scholar 

  66. Samama MM, Rached RA, Horellou MH, et al. Pregnancy-associated venous thromboembolism (VTE) in combined heterozygous factor V Leiden (FVL) and prothrombin (FII) 20210 A mutation and in heterozygous FII single gene mutation alone. Br J Haematol 2003;123:327–334.

    PubMed  CAS  Google Scholar 

  67. Gerhardt A, Scharf RE, Zotz RB. Effect of hemostatic risk factors on the individual probability of thrombosis during pregnancy and the puerperium. Thromb Haemost 2003;90:77–85.

    PubMed  CAS  Google Scholar 

  68. Levine JS, Branch DW, Rauch J. The antiphospholipid syndrome. N Engl J Med 2002;346:752–763.

    PubMed  CAS  Google Scholar 

  69. Lockwood CJ, Romero R, Feinberg RF, et al. The prevalence and biologic significance of lupus anticoagulant and anticardiolipin antibodies in a general obstetric population. Am J Obstet Gynecol 1989;161:369–373.

    PubMed  CAS  Google Scholar 

  70. Perez MC, Wilson WA, Brown HL, Scopelitis E. Anticardiolipin antibodies in unselected pregnant women. Relationship to fetal outcome. J Perinatol 1991;11:33–36.

    PubMed  CAS  Google Scholar 

  71. Harris EN, Spinnato JA. Should anticardiolipin tests be performed in otherwise healthy pregnant women? Am J Obstet Gynecol 1991;165:1272–1277.

    PubMed  CAS  Google Scholar 

  72. Crowther MA. Anticoagulant therapy for the thrombotic complications of the antiphospholipid antibody syndrome. Thromb Res 2004;114:443–446.

    PubMed  CAS  Google Scholar 

  73. Kearon C. Long-term management of patients after venous thromboembolism. Circulation 2004;110:110–118.

    Google Scholar 

  74. de Swiet M, Floyd E, Letsky E. Low risk of recurrent thromboembolism in pregnancy. Br J Hosp Med 1987;38:264.

    PubMed  Google Scholar 

  75. Badaracco MA, Vessey MP. Recurrence of venous thromboembolic disease and use of oral contraceptives. Br Med J 1974;1:215–217.

    PubMed  CAS  Google Scholar 

  76. Howell R, Fidler J, Letsky E, de Swiet M. The risks of antenatal subcutaneous heparin prophylaxis: a controlled trial. Br J Obstet Gynaecol 1983;90:1124–118.

    PubMed  CAS  Google Scholar 

  77. Tengborn L, Bergqvist D, Matzsch T, et al. Recurrent thromboembolism in pregnancy and puerperium. Is there a need for thromboprophylaxis? Am J Obstet Gynecol 1989;160:90–94.

    PubMed  CAS  Google Scholar 

  78. Brill-Edwards P, Ginsberg JS, Gent M, et al. Safety of withholding heparin in pregnant women with a history of venous thromboembolism. Recurrence of Clot in This Pregnancy Study Group. N Engl J Med 2000;343:1439–1444.

    PubMed  CAS  Google Scholar 

  79. Simioni P, Tormene D, Prandoni P, Girolami A. Pregnancy-related recurrent events in thrombophilic women with previous venous thromboembolism. Thromb Haemost 2001;86:929.

    PubMed  CAS  Google Scholar 

  80. Pabinger I, Grafenhofer H, Kyrle PA, et al. Temporary increase in the risk for recurrence during pregnancy in women with a history of venous thromboembolism. Blood 2002;100:1060–1062.

    PubMed  CAS  Google Scholar 

  81. Bell WR, Simon TL, DeMets DL. The clinical features of submassive and massive pulmonary emboli. Am J Med 1977;62:355–360.

    PubMed  CAS  Google Scholar 

  82. Wells PS, Anderson DR, Rodger M, 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;135:98–107.

    PubMed  CAS  Google Scholar 

  83. Ginsberg JS, Hirsh J, Rainbow AJ, Coates G. Risks to the fetus of radiologic procedures used in the diagnosis of maternal venous thromboembolic disease. Thromb Haemost 1989;61:189–196.

    PubMed  CAS  Google Scholar 

  84. Kearon C. Excluding pulmonary embolism with helical (spiral) computed tomography: evidence is catching up with enthusiasm. CMAJ 2003;168:1430–1431.

    PubMed  Google Scholar 

  85. Winer-Muram HT, Boone JM, Brown HL, et al. Pulmonary embolism in pregnant patients: fetal radiation dose with helical CT. Radiology 2002;224:487–492.

    PubMed  Google Scholar 

  86. Diederich S, Lenzen H. Radiation exposure associated with imaging of the chest: comparison of different radiographic and computed tomography techniques. Cancer 2000;89:2457–2460.

    PubMed  CAS  Google Scholar 

  87. Bremme K, Ostlund E, Almqvist I, et al. Enhanced thrombin generation and fibrinolytic activity in normal pregnancy and the puerperium. Obstet Gynecol 1992;80:132–137.

    PubMed  CAS  Google Scholar 

  88. Nolan TE, Smith RP, Devoe LD. Maternal plasma D-dimer levels in normal and complicated pregnancies. Obstet Gynecol 1993;81:235–238.

    PubMed  CAS  Google Scholar 

  89. Morse M. Establishing a normal range for D-dimer levels through pregnancy to aid in the diagnosis of pulmonary embolism and deep vein thrombosis. J Thromb Haemost 2004;2:1202–1204.

    PubMed  CAS  Google Scholar 

  90. Milne JA, Howie AD, Pack AI. Dyspnoea during normal pregnancy. Br J Obstet Gynaecol 1978;85:260–263.

    PubMed  CAS  Google Scholar 

  91. Kruip MJ, Slob MJ, Schijen JH, et al. Use of a clinical decision rule in combination with D-dimer concentration in diagnostic workup of patients with suspected pulmonary embolism: a prospective management study. Arch Intern Med 2002;162:1631–1635.

    PubMed  Google Scholar 

  92. Stein PD, Hull RD, Ghali WA, et al. Tracking the uptake of evidence: two decades of hospital practice trends for diagnosing deep vein thrombosis and pulmonary embolism. Arch Intern Med 2003;163:1213–1219.

    PubMed  Google Scholar 

  93. Hull RD, Hirsh J, Carter CJ, et al. Diagnostic value of ventilation-perfusion lung scanning in patients with suspected pulmonary embolism. Chest 1985;88:819–828.

    PubMed  CAS  Google Scholar 

  94. The PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). The PIOPED Investigators. JAMA 1990;263:2753–2759.

    Google Scholar 

  95. Kearon C. Natural history of venous thromboembolism. Circulation 2003;107:I22–I30.

    PubMed  Google Scholar 

  96. Chan WS, Chunilal SD, Lee AY, et al. Diagnosis of deep vein thrombosis during pregnancy: a pilot study evaluating the role of d-dimer and compression leg ultrasound during pregnancy. Blood 2002;100:275A (abstract).

    Google Scholar 

  97. Chunilal SD, Eikelboom JW, Attia J, et al. Does this patient have pulmonary embolism? JAMA 2003;290:2849–2858.

    PubMed  CAS  Google Scholar 

  98. Dempfle CE. Minor transplacental passage of fondaparinux in vivo. N Engl J Med 2004;350:1914–1915.

    PubMed  CAS  Google Scholar 

  99. Flessa HC, Kapstrom AB, Glueck HI, Will JJ. Placental transport of heparin. Am J Obstet Gynecol 1965;93:570–573.

    PubMed  CAS  Google Scholar 

  100. Forestier F, Daffos F, Capella-Pavlovsky M. Low molecular weight heparin (PK10169) does not cross the placenta during the second trimester of pregnancy study by direct fetal blood sampling under ultrasound. Thromb Res 1984;34:557–560.

    PubMed  CAS  Google Scholar 

  101. Forestier F, Daffos F, Rainaut M, Toulemonde F. Low molecular weight heparin (CY 216) does not cross the placenta during the third trimester of pregnancy. Thromb Haemost 1987;57:234.

    PubMed  CAS  Google Scholar 

  102. Ginsberg JS, Kowalchuk G, Hirsh J, et al. Heparin therapy during pregnancy. Risks to the fetus and mother. Arch Intern Med 1989;149:2233–2236.

    PubMed  CAS  Google Scholar 

  103. Ginsberg JS, Hirsh J, Turner DC, et al. Risks to the fetus of anticoagulant therapy during pregnancy. Thromb Haemost 1989;61:197–203.

    PubMed  CAS  Google Scholar 

  104. Sanson BJ, Lensing AW, Prins MH, et al. Safety of low-molecular-weight heparin in pregnancy: a systematic review. Thromb Haemost 1999;81:668–672.

    PubMed  CAS  Google Scholar 

  105. Rodie VA, Thomson AJ, Stewart FM, et al. Low molecular weight heparin for the treatment of venous thromboembolism in pregnancy: a case series. BJOG 2002;109:1020–1024.

    PubMed  CAS  Google Scholar 

  106. Sorensen HT, Johnsen SP, Larsen H, et al. Birth outcomes in pregnant women treated with low-molecular-weight heparin. Acta Obstet Gynecol Scand 2000;79:655–659.

    PubMed  CAS  Google Scholar 

  107. Ulander VM, Stenqvist P, Kaaja R. Treatment of deep venous thrombosis with low-molecular-weight heparin during pregnancy. Thromb Res 2002;106:13–17.

    PubMed  CAS  Google Scholar 

  108. Smith MP, Norris LA, Steer PJ, et al. Tinzaparin sodium for thrombosis treatment and prevention during pregnancy. Am J Obstet Gynecol 2004;190:495–501.

    PubMed  CAS  Google Scholar 

  109. Rowan JA, McLintock C, Taylor RS, North RA. Prophylactic and therapeutic enoxaparin during pregnancy: indications, outcomes and monitoring. Aust N Z J Obstet Gynaecol 2003;43:123–128.

    PubMed  Google Scholar 

  110. Lepercq J, Conard J, Borel-Derlon A, et al. Venous thromboembolism during pregnancy: a retrospective study of enoxaparin safety in 624 pregnancies. BJOG 2001;108:1134–1140.

    PubMed  CAS  Google Scholar 

  111. Ibbotson T, Perry CM. Danaparoid: a review of its use in thromboembolic and coagulation disorders. Drugs 2002;62:2283–2314.

    PubMed  CAS  Google Scholar 

  112. Lindhoff-Last E, Kreutzenbeck HJ, Magnani HN. Treatment of 51 pregnancies with danaparoid because of heparin intolerance. Thromb Haemost 2005;93:63–69.

    PubMed  CAS  Google Scholar 

  113. Quick AJ. Experimentally induced changes in the prothrombin level of the blood: III. Prothrombin concentrations of newborn pups of a mother given Dicoumarol before parturition. J Biol Chem 1946;164:371–376.

    CAS  Google Scholar 

  114. Hall JG, Pauli RM, Wilson KM. Maternal and fetal sequelae of anticoagulation during pregnancy. Am J Med 1980;68:122–140.

    PubMed  CAS  Google Scholar 

  115. Chan WS, Anand S, Ginsberg JS. Anticoagulation of pregnant women with mechanical heart valves: a systematic review of the literature. Arch Intern Med 2000;160:191–196.

    PubMed  CAS  Google Scholar 

  116. Hirsh J, Cade JF, Gallus AS. Fetal effects of coumadin administered during pregnancy. Blood 1970;36:623–627.

    PubMed  CAS  Google Scholar 

  117. Bates SM, Greer IA, Hirsh J, Ginsberg JS. Use of antithrombotic agents during pregnancy: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004;126:627S–644S.

    PubMed  CAS  Google Scholar 

  118. Orme ML, Lewis PJ, de Swiet M, et al. May mothers given warfarin breast-feed their infants? Br Med J 1977;1:1564–1565.

    PubMed  CAS  Google Scholar 

  119. McKenna R, Cole ER, Vasan U. Is warfarin sodium contraindicated in the lactating mother? J Pediatr 1983;103:325–327.

    PubMed  CAS  Google Scholar 

  120. Hull R, Delmore T, Carter C, et al. Adjusted subcutaneous heparin versus warfarin sodium in the long-term treatment of venous thrombosis. N Engl J Med 1982;306:189–194.

    PubMed  CAS  Google Scholar 

  121. Dolovich LR, Ginsberg JS, Douketis JD, et al. A meta-analysis comparing low-molecular-weight heparins with unfractionated heparin in the treatment of venous thromboembolism: examining some unanswered questions regarding location of treatment, product type, and dosing frequency. Arch Intern Med 2000;160:181–188.

    PubMed  CAS  Google Scholar 

  122. Shaughnessy SG, Hirsh J, Bhandari M, et al. A histomorphometric evaluation of heparin-induced bone loss after discontinuation of heparin treatment in rats. Blood 1999;93:1231–1236.

    PubMed  CAS  Google Scholar 

  123. Douketis JD, Ginsberg JS, Burrows RF, et al. The effects of long-term heparin therapy during pregnancy on bone density. A prospective matched cohort study. Thromb Haemost 1996;75:254–257.

    PubMed  CAS  Google Scholar 

  124. Barbour LA, Kick SD, Steiner JF, et al. A prospective study of heparin-induced osteoporosis in pregnancy using bone densitometry. Am J Obstet Gynecol 1994;170:862–869.

    PubMed  CAS  Google Scholar 

  125. Dahlman TC. Osteoporotic fractures and the recurrence of thromboembolism during pregnancy and the puerperium in 184 women undergoing thromboprophylaxis with heparin. Am J Obstet Gynecol 1993;168:1265–1270.

    PubMed  CAS  Google Scholar 

  126. Monreal M, Lafoz E, Olive A, et al. Comparison of subcutaneous unfractionated heparin with a low molecular weight heparin (Fragmin) in patients with venous thromboembolism and contraindications to coumarin. Thromb Haemost 1994;71:7–11.

    PubMed  CAS  Google Scholar 

  127. Pettila V, Kaaja R, Leinonen P, et al. Thromboprophylaxis with low molecular weight heparin (dalteparin) in pregnancy. Thromb Res 1999;96:275–282.

    PubMed  CAS  Google Scholar 

  128. Carlin AJ, Farquharson RG, Quenby SM, et al. Prospective observational study of bone mineral density during pregnancy: low molecular weight heparin versus control. Hum Reprod 2004;19:1211–1214.

    PubMed  CAS  Google Scholar 

  129. Warkentin TE. Heparin-induced thrombocytopenia: pathogenesis and management. Br J Haematol 2003;121:535–555.

    PubMed  CAS  Google Scholar 

  130. Lindhoff-Last E, Nakov R, Misselwitz F, et al. Incidence and clinical relevance of heparin-induced antibodies in patients with deep vein thrombosis treated with unfractionated or low-molecular-weight heparin. Br J Haematol 2002;118:1137–1142.

    PubMed  CAS  Google Scholar 

  131. Schindewolf M, Mosch G, Bauersachs RM, Lindhoff-Last E. Safe anticoagulation with danaparoid in pregnancy and lactation. Thromb Haemost 2004;92:211.

    PubMed  CAS  Google Scholar 

  132. Hirsh J, Raschke R. Heparin and low-molecular-weight heparin: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004;126:188S–203S.

    PubMed  CAS  Google Scholar 

  133. Ginsberg JS, Chan WS, Bates SM, Kaatz S. Anticoagulation of pregnant women with mechanical heart valves. Arch Intern Med 2003;163:694–698.

    PubMed  Google Scholar 

  134. Casele HL, Laifer SA, Woelkers DA, Venkataramanan R. Changes in the pharmacokinetics of the low-molecular-weight heparin enoxaparin sodium during pregnancy. Am J Obstet Gynecol 1999;181:1113–1117.

    PubMed  CAS  Google Scholar 

  135. Shiach CR. Monitoring of low molecular weight heparin in pregnancy. Hematology 2003;8:47–52.

    PubMed  CAS  Google Scholar 

  136. Barbour LA, Oja JL, Schultz LK. A prospective trial that demonstrates that dalteparin requirements increase in pregnancy to maintain therapeutic levels of anticoagulation. Am J Obstet Gynecol 2004;191:1024–1029.

    PubMed  CAS  Google Scholar 

  137. Chunilal SD, Young E, Johnston MA, et al. The APTT response of pregnant plasma to unfractionated heparin. Thromb Haemost 2002;87:92–97.

    PubMed  CAS  Google Scholar 

  138. Ahearn GS, Hadjiliadis D, Govert JA, Tapson VF. Massive pulmonary embolism during pregnancy successfully treated with recombinant tissue plasminogen activator: a case report and review of treatment options. Arch Intern Med 2002;162:1221–1227.

    PubMed  Google Scholar 

  139. Patel RK, Fasan O, Arya R. Thrombolysis in pregnancy. Thromb Haemost 2003;90:1216–1217.

    PubMed  Google Scholar 

  140. Yap LB, Alp NJ, Forfar JC. Thrombolysis for acute massive pulmonary embolism during pregnancy. Int J Cardiol 2002;82:193–194.

    PubMed  CAS  Google Scholar 

  141. Aya AG, Saissi G, Eledjam JJ. In situ pulmonary thrombolysis using recombinant tissue plasminogen activator after cesarean delivery. Anesthesiology 1999;91:578–579.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Haematology, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia

    Simon J. McRae MBBS

  2. Department of Medicine, McMaster University, Hamilton, Ontario, Canada

    Shannon M. Bates MDCM, MSc

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  1. Simon J. McRae MBBS
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  2. Shannon M. Bates MDCM, MSc
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Editors and Affiliations

  1. Department of Cardiology and Pulmonology, Georg August University, Goettingen, Germany

    Stavros V. Konstantinides MD (Professor of Medicine) (Professor of Medicine)

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© 2007 Humana Press Inc., Totowa, NJ

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McRae, S.J., Bates, S.M. (2007). Pulmonary Embolism in Pregnancy. In: Konstantinides, S.V. (eds) Management of Acute Pulmonary Embolism. Contemporary Cardiology. Humana Press. https://doi.org/10.1007/978-1-59745-287-8_17

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  • DOI: https://doi.org/10.1007/978-1-59745-287-8_17

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