Investigação da trombose venosa na gravidez

BACKGROUND: Deep venous thrombosis (DVT) during pregnancy is a determining factor that contributes to increased maternal-fetal morbidity and mortality. It may occur when there is thrombophilia, due to compression of the inferior vena cava, venous stasis or hormonal changes. OBJECTIVES: To assess patients who are pregnant or have just given birth and who have a DVT condition in the lower limbs, to search for possible causes of thrombophilia and to perform a review of the literature. METHODS: Pregnant and puerperal patients were assessed by gynecologists and obstetricians when there was suspicion of DVT, from January 2004 through November 2006, during which time there were 24,437 childbirths at Hospital e Maternidade Sao Luiz; of these, 89% were cesarean, 7.5% were normal births and 3.5% were forceps deliveries. Of the total number of patients referred with a clinical status suggesting DVT, 42 cases were clinically diagnosed as DVT, in pregnant women aged between 21-39 years, confirmed by venous duplex scan. Right before the introduction of anticoagulant therapy, samples were collected to investigate thrombophilia, which were repeated after the treatment. RESULTS: Of the 42 patients with DVT, 32 were primigravid (three twin pregnancies with no thrombophilic changes, two resulting from in vitro fecundation), eight were mothers at second birth and two were at third birth. In four patients, DVT occurred in the first trimester of pregnancy (9.5%), in 11 patients DVT was present in the second trimester (26.2%) and in 27 patients the disease developed in the third trimester of pregnancy (64.3%). Of the 42 patients diagnosed with DVT, 18 (42.8%) occurred in infrapatellar veins. There was a case of pulmonary thromboembolism in a 37-year-old patient, who had been submitted to in vitro fecundation, with twin pregnancy and a diagnostic of DVT (no thrombophilia) after a cesarean section. Of the 42 patients, 16 (38.1%) had the cause of their DVT determined, with a prevalence of heterozygous mutation of factor V Leiden in six patients (14.2%), followed by phospholipid syndrome and other causes. Most patients were treated with low-molecular-weight heparin. CONCLUSION: DVT during pregnancy, despite having low frequency, is a major cause of increased maternal-fetal morbidity. Investigation of thrombophilia should be conducted in selected cases, such as personal or family history of thrombotic phenomena and/or thrombophilia. Twin pregnancy, cesarean birth and artificial insemination were also found as factors leading to DVT.