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Venös tromboemboli under graviditet

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Sakkunnig:
Definition:
Venös tromboembolism – ventrombos och/eller lungembolism – som utvecklas under graviditeten eller de första veckorna efter förlossningen.
Förekomst:
Djup ventrombos (DVT) och lungemboli (LE) förekommer i 0,5–2 av 1 000 graviditeter. Cirka hälften av dessa episoder inträffar under de närmaste veckorna efter förlossningen.
Symtom: 
DVT – svullnad och smärta i benet, ökad omkrets, lokal rodnad. LE – dyspné, bröstsmärtor, smärta vid djupandning, eventuellt hosta och hemoptys.
Kliniska fynd:
Svullnad och rodnad i benet, lokal temperaturökning. Eventuellt biljud över lungorna, takypné, och sänkt perifer syremättnad vid LE.
Diagnostik:
DVT diagnostiseras med venöst kompressionsultraljud. LE bekräftas med DT angiografi eller skintigrafi. Wells score för skattning av klinisk sannolikhet för DVT eller LE är inte tillräckligt utvärderade för gravida. Inte heller D-dimer kan användas för att bedöma sannolikhet för DVT eller LE hos gravida.
Behandling:
Antikoagulantia med lågmolekylärt heparin under graviditet och lågmolekylärt heparin eller warfarin under amningsperioden.
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  • Maria Sennström, överläkare, PO Graviditet och förlossning, Karolinska universitetssjukhuset Solna
  • Anna Nager, docent och specialist i allmänmedicin, Karolinska institutet
  • Ingard Løge, spesialist allmennmedisin, redaktør NEL