حاملگی و آمبولی ریه؛ چالشی مرگ‌بار: مطالعه مروری

نوع مقاله : مروری

نویسندگان

1 استادیار گروه طب اورژانس، دانشکده پزشکی، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

2 متخصص زنان و زایمان، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

چکیده

مقدمه: آمبولی ریه به‌عنوان یکی از عوارض غیرمامایی نسبتاً شایع در حاملگی بوده و از علل مهم مورتالیتی در بارداری می­باشد. با توجه به برخی تغییرات فیزیولوژیک و هورمونی، ریسک آمبولی ریه در بارداری و دوران پس از زایمان افزایش می­یابد. مطالعه مروری حاضر با هدف بررسی آخرین مقالات مرتبط با روش‌های تشخیصی و درمان این بیماری انجام شد.
روش‌کار: در این مطالعه مروری پایگاه­های اطلاعاتی google scholar، PubMed، Embase، MedLine، Iranmedex و IranDoc با استفاده از معادل لاتین و Mesh کلمات pulmonary embolism، thromboembolism، pregnancy، anticoagulant، thrombolytic و thrombectomy به‌صورت نظام‌مند در بازه زمانی 1990 تا 2021 جستجو گردید.
یافته‌ها: در این مطالعه مروریدر نهایت 62 مقاله مورد بررسی قرار گرفت که تمرکز این مقالات بر پاتوفیزیولوژی، علائم بالینی، روش‌های تشخیص و درمان آمبولی ریه در بارداری متمرکز بود.
نتیجه‌گیری: تشخیص آمبولی ریه نیازمند شک بالینی بالاست. با توجه به خطرات اشعه یونیزان برای جنین، استفاده صحیح از الگوریتم‌های تشخیصی می­تواند خطر برخورد اشعه به مادر و جنین را کاهش دهد. درمان اصلی در موارد آمبولی ریه در بارداری، استفاده از داروهای آنتی‌کواگولان تزریقی همانند آنوکساپارین می­باشد. داروهای آنتی‌کوآگولان خوراکی در بارداری توصیه نمی‌شوند. همچنین در موارد آمبولی ریه ماسیو و تهدید کننده حیات می­توان از درمان با داروهای ترومبولیتیک و روش‌های جراحی برداشت لخته نیز استفاده نمود.

کلیدواژه‌ها

عنوان مقاله [English]

Pregnancy and pulmonary embolism; a fatal challenge: literature review

نویسندگان [English]

  • Bahram Zarmehri 1
  • Hoda Zabihi 2
1 Assistant Professor, Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
2 Gynecologist, Mashhad University of Medical Sciences, Mashhad, Iran
چکیده [English]

Introduction: Pulmonary embolism, as a relatively common non-obstetrics complication, is an important cause of maternal mortality during pregnancy. Due to some physiological and hormonal changes, the risk of pulmonary embolism increases during pregnancy and postpartum. This review article was performed with aim to explore the last articles related to diagnostic methods and treatment of this disease.  
Methods: In this review article, databases of Google scholar, PubMed, Embase, Medline, Iranmedex and IranDoc were systematically searched using the keywords of pulmonary embolism, thromboembolism, pregnancy, anticoagulant, thrombolytic and thrombectomy during 1990 to 2021.
Results: In this review article, finally 62 studies regarding pathophysiology, clinical feature, diagnostic strategies and treatment of pulmonary embolism during pregnancy were investigated.
Conclusion: The diagnosis of pulmonary embolism during pregnancy needs a high clinical suspicious. Due to the dangers of ionizing radiation to the fetus, correct using of diagnostic algorithms can reduce diminish radiation exposure to mother and fetus. Use of injectable anticoagulants such as enoxaparin is the main treatment method of pulmonary embolism during pregnancy. Oral anticoagulants are not recommended in pregnant women. Also, thrombolytic therapy and surgical thrombectomy can be used in the case of massive and life threatening pulmonary embolism.

کلیدواژه‌ها [English]

  • Anticoagulant
  • Pregnancy
  • Pulmonary embolism

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