Lege Artis Medicinae

[ANTICOAGULATION IN OBSTETRICS]

DOMJÁN Gyula, GADÓ Klára

MAY 21, 2006

Lege Artis Medicinae - 2006;16(05)

[The risk of thrombosis is increased about 5 to10 times during pregnancy and in the puerperium. Beside the classic risk factors, this is also due to special obstetrical causes. Delivery, especially Cesarean section further increases susceptibility to thrombosis. Prophylactic or therapeutic anticoagulant treatment can significantly reduce maternal and fetal morbidity and mortality. Just like in the non-pregnant state, subcutaneous low molecular weight heparin or intravenous or subcutaneous unfractionated heparin is recommended in pregnancy if anticoagulation is indicated. Warfarin is contraindicated in the first trimester because of its teratogenicity and also in the third trimester because of its long-lasting effect. Heparin does not cross the placenta, but its long-term administration may cause several side effects. Dosage, starting time and duration of the treatment depend on the measure of the risk of thrombosis. In certain cases (such as antiphospholipid syndrome) anticoagulant therapy is supplemented by low-dose acetylsalicylic acid. The date of delivery can be electively planned to minimalize bleeding and thrombotic complications. Vaginal delivery is preferred because of its lower risk of bleeding compared to Cesarean section. Intensity of anticoagulant therapy in the peripartum period should depend on the risk of thrombosis. The third phase of delivery should be actively driven by giving oxytocin to avoid bleeding complications. Since anticoagulant therapy is often continued during breast-feeding, it is important to know that neither warfarin, nor heparin is secreted in milk. When planning the treatment, each case requires individual consideration based on the type and number of risk factors, gestation time and, importantly, compliance of the patient.]

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