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Pedoman direvisi pada pengurangan risiko , pilihan pengobatan untuk penyakit tromboemboli pada kehamilan

Saran untuk mencegah dan mengobati tromboemboli vena ( VTE ) selama kehamilan , kelahiran dan setelah melahirkan diuraikan dalam dua pedoman baru  direvisi  . VTE jarang pada kehamilan atau dalam 6 minggu pertama postnatal dan risiko absolut sekitar 1 dari 1.000 kehamilan . Hal ini dapat terjadi pada setiap tahap kehamilan , tetapi saat risiko tertinggi adalah 6 minggu pertama setelah kelahiran , ketika risiko meningkat 20 kali lipat .....read more

Revised
guidelines on reducing risk, treatment options for thromboembolic disease in
pregnancy

Date:

April 16, 2015

Source:

Wiley

Summary:

Advice on preventing
and treating venous thromboembolism (VTE) during pregnancy, birth and following
delivery is outlined in two new revised guidelines. VTE is uncommon in
pregnancy or in the first 6 weeks postnatally and the absolute risk is around 1
in 1,000 pregnancies. It can occur at any stage in pregnancy, but the time of
the highest risk is the first 6 weeks following birth, when the risk increases
20-fold.

.........................

advice on preventing and
treating venous thromboembolism (VTE) during pregnancy, birth and following
delivery is outlined in two new revised guidelines published by the Royal
College of Obstetricians and Gynaecologists (RCOG) and launched at the RCOG
World Congress in Brisbane, Australia.

VTE refers to the formation of a clot within veins. This can occur anywhere
in the venous system, but the predominant sites are in the vessels of the leg
(giving rise to deep vein thrombosis (DVT)) and in the lungs (resulting in a
pulmonary embolism (PE)).

The Green-top Guidelines provide information, based on clinical evidence,
to assist clinicians with both the prevention and treatment of VTE in pregnant
women, a condition which remains the leading direct cause of maternal death in
the UK.

VTE is uncommon in pregnancy or in the first 6 weeks postnatally and the
absolute risk is around 1 in 1,000 pregnancies. It can occur at any stage in
pregnancy, but the time of the highest risk is the first 6 weeks following
birth, when the risk increases 20-fold.

Risk factors include previous VTE or thrombophilia (a tendency to form
blood clots), obesity, increased maternal age, immobility and long-distance
travel, admission to hospital during pregnancy and other comorbidities such as
heart disease, inflammatory bowel disease and pre-eclampsia.

Additional risk factors occurring during the first trimester of pregnancy
include hyperemesis gravidarum, ovarian hyperstimulation and IVF pregnancy.
Caesarean section is also a risk factor.

The guidelines emphasise that all women should undergo a thorough
assessment for VTE in early pregnancy or pre-pregnancy and again intrapartum or
immediately postpartum.

Any woman with risk factors should be considered for prophylactic
low-molecular-weight-heparin (LMWH), an injection administered to thin the
blood. The duration of treatment depends on the number of risk factors a woman
has. It may be offered both antenatally and after the baby is born.

In addition, women with previous VTE must be offered pre-pregnancy
counselling. A prospective management plan for VTE should also be made,
including appropriate treatment to be offered as early as possible and a
careful history documented.

The guidance on treating VTE focuses on the acute management of the
condition and highlights the signs and symptoms, including leg pain and
swelling, lower abdominal pain, shortness of breath, chest pain, coughing blood
and collapse.

Any woman presenting with signs and symptoms suggestive of VTE should be
tested for the condition immediately and offered treatment with
low-molecular-weight heparin (LMWH). All hospitals should have a protocol for
the diagnosis of suspected VTE, with the involvement of a multi-disciplinary
team of obstetricians, radiologists, physicians and haematologists.

Professor Catherine Nelson-Piercy, lead author of the guidance on
preventing thromboembolism says: "Venous thromboembolism is rare in
pregnancy and with prompt recognition can be treated effectively. This guidance
provides clinicians with accurate scientific-based guidelines on the risk
factors for VTE, as well as on how to prevent and treat the condition.

"It is vital that VTE is discussed with all women who are at risk and
the reasons for individual treatment recommendations must also be
explained."

Dr Andrew Thomson, lead author of the guideline on treating thromboembolism
and co-Chair of the RCOG Guidelines Committee says: "Previous editions of
these guidelines have been credited with a reduction in the number of women
dying from thromboembolism during their pregnancy or in the postnatal period in
the UK. Nonetheless, thromboembolism remains an important cause of maternal
morbidity and mortality in our country.

"These updated guidelines provide new evidence about risk factors for
thrombosis in pregnancy and strategies that should be employed to reduce the
chances of a thrombosis occurring. Furthermore, the guidelines provide updated
information on the way women with a suspected thrombosis should be investigated
and treated."







Story Source:

The above story is based on materials provided by Wiley. Note: Materials may be edited
for content and length.

http://www.sciencedaily.com/releases/2015/04/150416132334.htm

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