妊娠相关静脉血栓栓塞症53例临床特点分析

Clinical characteristics of 53 cases of pregnancy associated venous thromboembolism

目的分析妊娠相关静脉血栓栓塞症(pregnancy associated venous thromboembolism, PA-VTE)的临床特点。方法回顾性分析2010年10月至2019年4月年北京大学第三医院产科收治的PA-VTE 53例临床资料。结果(1) 53例患者中,30例(56.6%)发生于产褥期,23例(43.4%)发生于妊娠期;(2)肺栓塞4例(7.55%),均为急诊剖宫产术后发生;(3)晚期妊娠8例(15.1%),中期妊娠4例(7.5%),早期妊娠11例(20.8%),妊娠早中期VTE多合并非妊娠相关高危因素;(4)剖宫产后产褥期23例(76.7%),阴道分娩后7例(23.3%),均无VTE家族史。结论不同妊娠阶段PA-VTE致病因素不同,妊娠早期多与血栓前状态等非产科因素相关,随妊娠进展至产褥期,妊娠相关高危因素逐步增加,分娩期并发症是产褥期PA-VTE重要因素。

Objective To summarize and analyze the clinical characteristics of pregnancy associated venous thromboembolism(PA-VTE). Methods The clinical data of 53 cases of PA-VTE admitted to Peking University Third Hospital from October 2010 to April 2019 were retrospectively analyzed. Results(1) Of the 53 patients, 30 cases(56.6%) occurred during puerperium and 23 cases(43.4%) during pregnancy.(2) Pulmonary embolism occurred in 4 cases(7.55%), all of which occurred after emergency cesarean section.(3) There were 8 cases(15.1%) in the third trimester, 4 cases(7.5%) in the second trimester, and 11 cases(20.8%) in the first trimester. VTE in the first and second trimesters was associated with nonpregnancy-related risk factors.(4) There was no family history of VTE in 23 cases(76.7%) during puerperium after cesarean section and 7 cases(23.3%) after vaginal delivery. Conclusions The occurrence of VTE in early pregnancy is more related to the prethrombotic status and other non-ovstetric factors. With the development of pregnancy to puerperium, the risk of VTE caused by pregnancy related high-risk factors increases gradually.