Cardiac Surgery and Obstetric Strategy for Thromboembolic Complications in Pregnant Women and Parturients

Abstract

Venous thromboembolism (VTE), and specifically its manifestation – pulmonary embolism (PE) – is the most common direct cause of maternal mortality in the world and ranks 3-4th among the causes of maternal mortality in Ukraine. The multidisciplinary team (pregnancy heart team) established at two academic institutions in 2013, presents its experience of treating VTE in pregnant women and parturients, as well as analysis of common pitfalls of medical care for pregnant women with VTE. The group of pregnant women (parturients) with VTE consisted of 8 patients, 6 of whom were pregnant, 2 were parturients. In 2 pregnant women and 2 parturients with high-risk PE, 4 surgical procedures were performed (three open-heart surgeries – thromboectomy from pulmonary artery, one endovascular inferior vena cava filter implantation), including a pregnant woman (24–25 week) with a massive high-risk PE who underwent an urgent surgery – pulmonary artery thrombectomy and a tricuspid valve repair (with fetus in utero) with prolongation of pregnancy to 39 weeks and the birth of a healthy baby. One perinatal twin loss was observed in patient after extracorporeal fertilization and acute VTE. The main causes of the VTE are the underestimation of risk factors in preconceptional counseling, and the lack of pre-gravid preparation of women, as well as the prevention of the development of venous thrombosis in ante-, intra- and postnatal periods. The diagnosis of VTE and PE in time, and competent medical support provided for such women during pregnancy is a key to minimizing cardiovascular risks and reducing maternal mortality rates. The National Pregnancy Heart Team presents algorithms for primary and secondary prevention and treatment of VTE.

Keywords

• venous thromboembolism
• pregnancy
• cardiac surgery