THE POSITIVE EXPERIENCE OF MATERNITY AND CHILDBIRTH WITH POSTTHROMBOPHLEBITIC SYNDROME AND PULMONARY EMBOLISM DURING PREGNANCY

Maternity and childbirth with venous thromboembolic complications (VTC) is one of the most urgent problems of modern obstetrics. Being a rare complication of normal pregnancy, VTC occupy one of the leading places among the causes of maternal mortality. According to the latest data, venous thrombosis occurs in approximately 0.42% of pregnant women and 3.5% of puerperants. In the overwhelming majority of cases, it is complicated by pulmonary embolism, which in the absence of adequate treatment, leads to death of every third woman. The natural physiology of pregnancy increases the risk of thromboembolic complications by 4-6 times. There is a progressive increase in the content of procoagulant factors, decrease in the activity of the anticoagulant and fibrinolytic system. The rate of venous blood flow significantly decreases, mainly due to the disruption of venous outflow under the pressure of the pregnant uterus. Thus, pregnancy is a condition, in which thromboembolic complications can develop suddenly, without any previous risk factors. Every case of VTC is a serious problem for doctors. Only few cases of applying thrombolytic therapy in pregnant woman are described in the literature. There is no evidence base for the safety of thrombolysis drugs for the fetus. There are no clear guidelines for the management and tactics of delivery of this category of pregnant women and the question, how to lead the pregnancy in such a situation, is still a matter of debate. We want to share a unique experience in the management of pregnancy and childbirth of the woman with postthrombophlebitic syndrome and pulmonary embolism during pregnancy.