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2016 | OriginalPaper | Buchkapitel

24. Thromboembolische Komplikationen in Schwangerschaft und Wochenbett

verfasst von : Ronald Fischer, Thorsten Fischer

Verlag: Springer Berlin Heidelberg

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Zusammenfassung

Thromboembolische Erkrankungen sind in den Industrieländern eine der häufigsten Ursachen mütterlicher Mortalität. Tiefe Venenthrombosen oder Lungenembolien treten in der Schwangerschaft etwa 4–6×, im Wochenbett 20–30× häufiger auf als bei nichtschwangeren Frauen. Das Risiko steigt bereits im 1. Trimenon und bleibt im weiteren Verlauf unverändert. Immobilisation, Trauma, insbesondere operative Traumata, Dehydratation und Infektionen stellen zusätzliche Risikokonstellationen dar.

Das erhöhte Risiko thromboembolischer Komplikationen in Schwangerschaft und Wochenbett rechtfertigen die intensiven Bemühungen, von einer Thrombose bedrohte Schwangere rechtzeitig zu erkennen und prophylaktisch zu behandeln. Mit den niedermolekularen Heparinen hat sich eine Therapieoption durchgesetzt, die bei hoher Effektivität ein günstigeres Nebenwirkungsprofil aufweist. Damit haben sich für viele Frauen Möglichkeiten eröffnet, trotz individuell erhöhter Risikokonstellation eine Schwangerschaft auszutragen.

Vorheriges Kapitel Anämie in der Schwangerschaft

Nächstes Kapitel Infektionen in der Schwangerschaft und bei der Geburt

Alfirevic Z, Roberts D, Martlew V (2002) How strong is the association between maternal thrombophilia and adverse pregnancy outcome? A systemic review. Eur J Obstet Gynecol Reprod Biol 101:6–14PubMedCrossRef

Al-Toma A, Heggelman BGF, Kramer MHH (2003) Postpartum ovarian vein thrombosis: report of a case and review of literature. Neth J Med 61:334–336PubMed

American College of Obstetricians and Gynecologists (2000) Thromboembolism in pregnancy. ACOG Pract Bull No 19

Andersen BS, Steffensen FH, Sorensen HT, Nielsen GL, Olsen J (1998) The cumulative incidence of venous thromboembolism during pregnancy and puerperium – an 11 year Danish population-based study of 63,300 pregnancies. Acta Obstet Gynecol Scand 77:170–173PubMedCrossRef

Aschwanden M, Labs KH, Engel H, Schwob A, Jeanneret C, Mueller-Brandt J, Jaeger KA (2001) Acute deep vein thrombosis: early mobilisation does not increase the frequency of pulmonary embolism. Thromb Haemost 85:42–46PubMed

AWMF Leitlinienregister Nr. 003/001 (2010) S3-Leitlinie Prophylaxe der venösen Thromboembolie (VTE)

AWMF-Leitlinien-Register Nr. 015/018 (2007) Diagnostik und Therapie hypertensiver Schwangerschaftserkrankungen

AWMF-S3-Leitlinie 003/001: Prophylaxe der venösen Thromboembolie (VTE) (2010). http://www.leitlinien-net/003-001I.pdf. (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften; AWMF). Zugegriffen am 30.11.2013

Barbour LA, Kick SD, Steiner JF et al (1994) A prospective study of heparin-induced osteoporosis in pregnancy using bone densitometry. Am J Obstet Gynecol 170:862–869PubMedCrossRef

Bardett Fausett M, Vogtlander M, Lee RM, Esplin MS, Branch DW, Rodgers GM, Silver RM (2001) Heparin-induced thrombocytopenia is rare in pregnancy. Am J Obstet Gynecol 185:148–152CrossRef

Bates SM, Ginsberg JG (1997) Antikoagulants in pregnancy: fetal defects. Bailliere’s Clinl Obstet Gynecol 11:479–488CrossRef

Bates SB, Greer IA, Hirsh J, Ginsberg JS (2004) Use of antithrombotic agents during pregnancy. Chest 126:627–644CrossRef

Bates SM, Greer IA, Pabinger I, Sofaer S, Hirsh J (2008) Venous thromboembolism, thrombophilia, antithrombotic therapy, and pregnancy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 133:844S–886SPubMedCrossRef

Bauersachs RM, Lindhoff-Last E, Wollf U, Ehrly AM (1999) Aktuelles Management der tiefen Venenthrombose. Med Welt 49:194–214

Bauersachs RM, Dudenhausen J, Faridi A, Fischer T, Fung S, Geisen U et al (2007) Risk stratification and heparin prophylaxis to prevent venous thromboembolism in pregnant women. Thromb Haemost 98:1237–1245PubMed

Beller FK, Winkler UH (1990) Varikose und thromboembolische Komplikationen. In: Beller FK, Kyank H (Hrsg.) Erkrankungen während der Schwangerschaft. VEB Thieme, Leipzig, S 193–201

Bennett SA, Bagot CN, Arya R (2012) Pregnancy loss and thrombophilia: the elusive link. Br J Haematol 157:529–542PubMedCrossRef

Berg CJ, Atrash HK, Koonin LM, Tucker M (1996) Pregnancy-related mortality in the United States, 1987–1990. Obstet Gynecol 88:161–167PubMedCrossRef

Arzneimittel-Schnellinformation des BfArM (1996) Dtsch Ärztebl 93:A 987

Boneu B, Bis G, Pelzer H et al (1991) D-dimers, thrombin-antithrombin III complexes and prothrombin fragments 1+2: diagnostic value in clinically suspected deep vein thrombosis. Thromb Haemost 65:28–32PubMed

Brill-Edwards P, Ginsberg JS, Gent M et al (2000) Safety of withholding heparin in pregnant women with a history of venous thromboembolism. N Engl J Med 343:1439–1444PubMedCrossRef

Carp H, Dolitzky M, Inbal A (2003) Thromboprophylaxis improves the live birth rate in women with consecutive recurrent miscarriages and hereditary thrombophilia. J Thromb Haemost 1:433–438PubMedCrossRef

Chan WS, Anand S, Ginsberg JS (2000) Anticoagulation of pregnant women with mechanical heart valves: a systemic review of the literature. Arch Intern Med 160:191–196PubMedCrossRef

Clark P, Walker ID, Langhorne P, Crichton L, Thomson A, Greaves M et al (2010) SPIN (Scottish Pregnancy Intervention) study: a multicenter, randomized controlled trial of low-molecular-weight heparin and low-dose aspirin in women with recurrent miscarriage. Blood 115:4162–4167PubMedCrossRef

Collins R, Petro R, MacMahon S, Hebert P, Fiebach NH, Eberlein KA et al (1990) Blood pressure, stroke, and coronary heart disease. Lancet 335:827–838PubMedCrossRef

Dahlman TC (1993) Osteoporotic fractures and the recurrence of thromboembolism during pregnancy and the puerperium in 184 women undergoing thromboprophylaxis with heparin. Am J Obstst Gynecol 168:1265–1270CrossRef

Decousus H, Epinat M, Guillot K, Quenet S, Boissier C, Tardy B (2003) Superficial vein thrombosis: risk factors, diagnosis, and treatment. Curr Opin Pulm Med 9:393–397PubMedCrossRef

Department of Health (1989) Confidential enquiries into maternal deaths in England and Wales 1982–1984. HMSO, London

Duhl AJ, Paidas MJ, Ural SH, Branch W, Casele H, Cox-Gill J (2007) Antithrombotic therapy and pregnancy: consensus report and recommendations for prevention and treatment of venous thromboembolism and adverse pregnancy outcomes. Am J Obstet Gynecol 197:457.e1-21PubMedCrossRef

Evans W, Laifer SA, McNanley TJ, Ruzycky A (1997) Management of thromboembolic disease associated with pregnancy. J Matern Fetal Med 6:21–27PubMedCrossRef

Fässler M, Zimmermann R, QuackLöscher KC (2010) Maternal mortality in Switzerland. Swiss Med Weekly 140:25–30

Fischer T, Klockenbusch W, Rath W (2008) Diagnostik und Therapie hypertensiver Schwangerschaftserkrankungen. Frauenarzt 49:950–954

Francis CS, Marder VJ (1991) Fibrinolytic therapy for venous thrombosis. Prog Cardiovasc Dis 34:193–204PubMedCrossRef

Franks AL, Atrash HK, Lawson HW, Colberg KS (1990) Obstetrical pulmonary embolism mortality, United States, 1970-85. Am J Public Health 80:720–722PubMedPubMedCentralCrossRef

Gakhal MS, Levy HM, Spina M, Wrigley C (2013) Ovarian vein thrombosis: analysis of patient age, etiology, and side of involvement. Del Med J 85:45–50PubMed

Galli M, Barbui T (2003) Antiphospholipid antibodies and pregnancy. Best Pract Res Clin Haematol 16:211–225PubMedCrossRef

Garcia J, Aboujaoude R, Apuzzio J (2006) Septic pelvic thrombophlebitis: diagnosis and management. Infect Dis Obstet Gynecol 15614:1–4CrossRef

Gibson PS, Powrie R (2009) Anticoagulants and pregnancy: when are they safe? Cleve Clin J Med 76:113–127PubMedCrossRef

Ginsberg JS, Hirsh J (1989) Use of anticoagulants during pregnancy. Chest 95:156–160CrossRef

Ginsberg JS, Hirsh J, Rainbow AJ, Coates G (1989) Risks to the fetus of radiological procedures used in the diagnosis of maternal venous thromboembolic disease. Thromb Haemost 61:189–196PubMed

Ginsberg JS, Greer I, Hirsh J (2001) Use of antithrombotic agents during pregnancy. Chest 119:122S–131SPubMedCrossRef

Gogarten W, Van Aken H, Büttner J, Riess H, Wulf H, Bürkle H (2007) Rückenmarksnahe Regionalanästhesien und Thromboembolieprophylaxe/antithrombotische Medikation: 2. überarbeitete Empfehlung der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin. Anästh Intensivmed 48:S109–S124

Goldhaber SZ, Buring JE, Lipnick RJ, Hennekens CK (1984) Pooled analysis of randomized trials of streptokinase and heparin in phlebographically documented acute deep venous thrombosis. Am J Med 76:393PubMedCrossRef

Gomez-Outes A, Lecumberri R, Lafuente-Guijosa A, Martinez-Gonzalez J, Carrasco P, Rocha E (2004) Correlation between thrombus regression and recurrent venous thromboembolism. Examining venographic and clinical effects of low-molecular-weight heparins: a meta-analysis. J Thromb Haemost 2:1581–1587PubMedCrossRef

Greer IA (1989) Thromboembolic problems in pregnancy. Fetal Med Rev 1:79–103CrossRef

Greer IA (1999) Thrombosis in pregnancy: maternal and fetal issues. Lancet 353:1258–1265PubMedCrossRef

Greer IA (2003) Prevention of venous thromboembolism in pregnancy. Best Pract Res Clin Haematol 16:261–278PubMedCrossRef

Greer A, Thomson AJ (2001) Management of venous thromboembolism in pregnancy. Best Pract Res Clin Obstet Gynecol 15:583–603CrossRef

Greer IA, Ginsberg JS, Greer IA, Hirsh J (2001) Use of antithrombotic agents during pregnancy. Chest 119:122–131CrossRef

Greinacher A, Eckhardt T, Mumann J, Müller-Eckhardt C (1993) Pregnancy complicated by heparin associated thrombocytopenia: management by a prospectively in vitro selected heparinoid (Org 10172). Thromb Res 71:123–126PubMedCrossRef

Gris JC, Mercier E, Quere I, Lavigne-Lissalde G, Cochery-Nouvellon E, Hoffet M et al (2004) Low-molecular-weight heparin versus low-dose aspirin in women with one fetal loss and a constitutional thrombophilic disorder. Blood 103:3695–3699PubMedCrossRef

Gris JC, Chauleur C, Molinari N, Mares P, Fabbro-Peray P, Quere I, Lefrant JY, Haddad B, Dauzat M (2011) Addition of enoxaparin to aspirin for the secondary prevention of placental vascular complication in women with severe pre-eclampsia. The pilot randomised controlled NOH-PE trial. Thromb Haemost 106:1053–1061PubMedCrossRef

Harenberg J, Leber G, Zimmermann R, Schmidt W (1987) Thromboembolieprophylaxe mit niedermolekularem Heparin in der Schwangerschaft. Geburtsh Frauenheilkd 47:15–18CrossRef

Heilmann L, Rath W, von Tempelhoff GF, Harenberg J, Breddin HK, Riess H, Schramm W (2002) Niedermolekulare Heparine in der Schwangerschaft. Dtsch Ärztebl 99:B342–B347

Heit JA, Kobbervig CE, James AH et al (2005) Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. 3rd. Ann Intern Med 143(10):697–706PubMedCrossRef

Hellgren M, Blomback M (1981) Blood coagulation and fibrinolysis in pregnancy, during delivery and in the puerperium. Gynecol Obstet Invest 12:141–154PubMedCrossRef

Hering D, Horstkotte D (2003) Einsatz niedermolekularer Heparine bei Kunstklappenträgern. Dtsch Med Wochenschr 128:1129–1133

Hering R, Gembruch U, Hertfelder HJ, Hoeft A (2005) Querschnittslähmung durch rückenmarksnahe Analgesie in der Geburtshilfe. Dtsch Ärztebl 102:1655–1659

Hirsh J, Fuster V (1994) Guide to anticoagulant therapy. Part 1: Heparin. Circulation 89:1449–1468PubMedCrossRef

Horstkotte D, Faßbender D, Piper C (2003) Angeborene Herzfehler und erworbene Herzklappenfehler in der Schwangerschaft. Herz 28:227–239PubMedCrossRef

Hull RD, Raskob GE, Coates G, Panju AA (1990) Clinical validity of a normal perfusion lung scan in patients with suspected pulmonary embolism. Chest 97:23–26PubMedCrossRef

Iturbe-Alessio I, del Carmen FM, Mutchinik O, Santos MA, Zajarias A, Salazar E (1986) Risk of anticoagulant therapy in pregnant women with artificial heart valves. N Eng J Med 315:1390–1393CrossRef

James AH, Tapson VF, Goldhaber SZ (2005) Thrombosis during pregnancy and the postpartum period. Am J Obstet Gynecol 193:216–219PubMedCrossRef

Kaandorp SP, Goddijn M, van der Post JA, Hutten BA, Verhoeve HR, Hamulyak K, Mol BW, Folkeringa N, Nahuis M, Papatsonis DN, Buller HR, van der Veen F, Middeldorp S (2010) Aspirin plus heparin or aspirin alone in women with recurrent miscarriage. NEJM 362:1586–1596PubMedCrossRef

Kujovich JL (2004) Thrombophilia and pregnancy complication. Am J Obstet Gynecol 191:412424CrossRef

Kupfermine MJ, Eldor A, Steinman N et al (1999) Increased frequency of genetic thrombophilia in women with complications of pregnancy. N Engl J Med 340:8–13

Kupfermine MJ, Fait G, Marry A, Lessing JB, Yair D, Bar-Am A, Eldor A (2001) Low-molecular-weight heparin for the prevention of obstetric complications in women with thrombophilias. Hypertens Pregnancy 20:25–44CrossRef

LeCuru F, Desnos M, Taurelle R (1996) Anticoagulant therapy in pregnancy: report of 54 cases. Acta Obstet Gynecol Scand 75:217–221PubMedCrossRef

Lee LA, Posner KL, Domino KB, Caplan RA, Cheney FW (2004) Injuries associated with regional anesthesia in the 1980s and 1990s: a closed claims analysis. Anesthesiology 101:143–152PubMedCrossRef

Letzky EA, Swiet M (1994) Maternal hemostasis: coagulation problems of pregnancy. In: Loscalzo J, Schafer AI (Hrsg) Thrombosis and hemorrhage. Blackwell, Oxford, S 965–998

Lichey J, Reschofski I, Dissmann T et al (1991) Fibrin degradation product D-dimer in the diagnosis of pulmonary embolism. Klin Wochenschr 69:522–526PubMedCrossRef

Martinelli I, Taioli E, Cetin I et al (2000) Mutations in coagulation factors in women with unexplained late fetal loss. N Engl J Med 343:1015–1018PubMedCrossRef

McNamee K, Dawood F, Farquharson R (2012) Recurrent miscarriage and thrombophilia: an update. Curr Opin Obstet Gynecol 24(4):229–234PubMedCrossRef

Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, Derksen RHWM, De Groot PG, Koike T, Merlon PL, Reber G, Schoenfeld Y, Tincani A, Vlachyiannopoulos PG, Krills A (2006) International consensus statement on an update of the classification criteria for definite antiphspholipid syndrome (APS). J Thrombosis Haemostasis 4:295–305CrossRef

Moen V, Dahlgren N, Irestedt L (2004) Severe neurological complications after central neuraxial blockades in Sweden 1990-1999. Anesthesiology 101:950–959PubMedCrossRef

Mogensen K, Skibsted L, Wadt J (1989) Thrombectomy of acute iliofemoral venous thrombosis during pregnancy. Surg Gynecol Obstet 169:50–54PubMed

Morrison ER, Miedzybrodzka ZH, Campbell DM, Haites NE, Wilson BJ, Watson MS et al (2002) Prothrombic genotypes are not associated with pre-eclampsia and gestational hypertension: results from a large poulation-based study and systemic review. Thromb Haemost 87:779–785PubMed

National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy (2000) Report of the National High Blood Pressure Education Program Working Group on high blood pressure in pregnancy. Am J Obstet Gynecol 183:S1–S22CrossRef

Oakley CM (1995) Anticoagulation and pregnancy. Eur Heart J 10:1317

Ortín X, Ugarriza A, Espax RM, Boixadera J, Llorente A, Escoda L, Cabezudo E (2005) Postpartum ovarian vein thrombosis. Thromb Haemost 93:1004–1005PubMed

Partsch H, Blättler W (1996) Leitlinien zur Thromboembolie-Prophylaxe. Phlebologie 25:261–266

Pauer HU, Voigt-Tschirschwitz T, Hinney B, Burfeind P, Wolf C, Emons G, Neesen J (2003) Analyzes of three common thrombophilic gene mutations in german women with recurrent abortions. Acta Obstet Gynecol Scand 82:942–947PubMedCrossRef

Rai R, Cohen H, Dave M, Regan L (1997) Randomised controlled trial of aspirin and aspirin plus heparin in pregnant women with recurrent miscarriage associated with phospholipid antibodies (or antiphospholipid antibodies). BMJ 314:253–257PubMedPubMedCentralCrossRef

Rand JH (2010) A snapy new concept for APS. Blood 116:1193–1194PubMedCrossRef

Rey E, Kahn SR, David M, Shrier I (2003) Thrombophilic disorders and fetal loss: a meta-analysis. Lancet 362:901–908CrossRef

Rey E, Garneau P, David M, Gauthier R, Leduc L, Michon N et al (2009) Dalteparin for the prevention of recurrence of placental-mediated complications of pregnancy in women without thrombophilia- a pilot randomized controlled trial. J Thromb Haemostas 7:58–64CrossRef

Robertson L, Wu O, Langhorne P, Twaddle S, Clark P, Lowe GD, Walker D, Greaves M, Brenkel I, Regan L, Greer IA (2006) Thrombophilia in pregnancy: a systematic review. Br J Haematol 132:171–196PubMedCrossRef

Romero A, Alonso C, Rincon M, Medrano J, Santos JM, Calderon E, Marin I, Gonzalez MA (2005) Risk of venous thromboembolic disease in women – a qualitative systematic review. Eur J Obstet Gyneco Reprod Biol 121:8–17CrossRef

Royal College of Obstetricians and Gynaecologists (2004) Thromboprophylaxis during pregnancy, labor and aftervaginal delivery (Guideline No. 37). www.rcog.org.uk/resources/Public/pdf/Thrombo-prophylaxis_no037.pdf. Zugegriffen am 30.11.2013

Ruehm SG, Zimmy K, Debatin JF (2001) Direct contrast-enhanced 3D MR venography. Eur Radiol 11:102–112PubMedCrossRef

Ruppen W, Derry S, McQuay H, Moore RA (2006) Incidence of epidural hematoma, infection, and neurologic injury in obstetric patients with epidural analgesia/anesthesia. Anesthesiology 105:394–399PubMedCrossRef

Sandler DA, Martin JF, Duncan JS et al (1984) Diagnosis of deep vein thrombosis: comparison of clinical evaluation, ultrasound, plethysmograph and venoscan with X-ray venogram. Lancet 2:716–719PubMedCrossRef

Sbarouni E, Oakley CM (1994) Outcome of pregnancy in women with valve prostheses. Br Heart J 71:196–201PubMedPubMedCentralCrossRef

Schindler JM, Kaiser M, Gerber A, Vuilliomenet A, Popovic A, Bertel O (1990) Colour coded duplex sonography in suspected deep vein thrombosis of the leg. BMJ 301:1369–1370PubMedPubMedCentralCrossRef

Schlembach D, Beinder E, Zingsem J, Wunsiedler U, Beckmann MW, Fischer T (2003) Association of maternal and/or fetal factor V Leiden and G20210A prothrombin mutation with HELLP syndrome and intrauterine growth retardation. Clin Sci 105:279–285PubMedCrossRef

Schleussner E (2006) Schwangerschaftskomplikationen, Thrombophilie und der Einsatz von niedermolekularen Heparinen – ein Update. Vascular Care 11:8–19

Siegert G, Tiebel O, Justus B (1992) Veränderungen von Gerinnungs- und Fibrinolyseparametern während des Verlaufes der normalen Schwangerschaft. Klin Lab 38:1136–1340

Singh S, McGlennan A, England A, Simons R (2012) A validation study of the CEMACH recommended modified early obstetric warning system (MEOWS). Anaesthesia 67:12–18PubMedCrossRef

Sipes SL, Weiner CP (1990) Venous thromboembolic disease in pregnancy. Semin Perinatol 14:103–118PubMed

Stein PD, Terrin ML, Hales CA et al (1991) Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no preexisting cardiac or pulmonary disease. Chest 100:598–603PubMedCrossRef

Stein W, Hawighorst T, Emons G (2008) Geburtshilfliche Koagulaopatien. Frauenheilkunde up2date 3:235–253CrossRef

Steinhard J, Baez E, Rody A, Klockenbusch W (2002) Thrombophilien und Schwangerschaftskomplikationen. Geburtsh Frauenheilkd 62:R161–R180

Takach TJ, Cevera RD, Gregoric ID (2005) Ovarian vein and caval thrombosis. Texas Heart Inst J 32:579–582

THRIFT: Thromboembolic Risk Factors Consensus Group (1992) Risk of and prophylaxis for venous thromboembolism in hospital patients. Br Med J 305:567–574CrossRef

Toglia MR, Weg JG (1996) Venous thromboembolism during pregnancy. N Engl J Med 335:108–114PubMedCrossRef

Twickler DM, Setiawan AT, Evans RS (1997) Imaging of puerperal septic thrombophlebitis. Prospective comparison of MR imaging, CT and sonography. Am J Roentgenol 169:1039–1043CrossRef

Tzortzatos G, Sioutas A, Beckman MO (2009) Ovarian vein thrombosis in the first trimester of pregnancy. Thromb Haemost 102:601–602PubMed

van Wersch JWJ, Ubachs JMH (1991) Blood coagulation and fibrinolysis during normal pregnancy. Eur J Clin Chem Clin Biochem 29:45–50PubMed

Verheugt FWA, Bolte AC (2011) The role of aspirin in women`s health. J Women’s Health 3:151–166

von Hugo R, Theiss W, Kuhn WG (1984) Thromboembolische Erkrankungen in der Geburtshilfe. Gynäkologe 17:115–123

Vries D, van Pampus MG, Hague WM, Bezemer PD, Joosten JH, FRUIT-investigators (2012) Low-molecular-weight heparin added to aspirin in the prevention of recurrent early-onst pre-eclampsia in women with inheritable thrombophilia: the FRUIT-RCT. J Thromb Haemost 10:64–72PubMedCrossRef

Warkentin TE, Levine N, Hirsh J et al (1995) Heparin-induced thrombocytopenia in patients treatet with low molecular-weight heparin or unfractionated heparin. N Engl J Med 332:1330–1335PubMedCrossRef

Winkler M, Rath W (1999) Septische Ovarialvenenthrombose. Gynäkologe 32:557–561

Winkler UH, Schindler AE (1996) Zur Prophylaxe und Behandlung der Thrombose in der Schwangerschaft. Geburtsh Frauenheilkd 56:301–312CrossRef

Titel: Thromboembolische Komplikationen in Schwangerschaft und Wochenbett
verfasst von: Ronald Fischer
Thorsten Fischer
Verlag: Springer Berlin Heidelberg
Buch: Die Geburtshilfe
Print ISBN: 978-3-662-45063-5

Electronic ISBN: 978-3-662-45064-2

Copyright-Jahr: 2016
DOI: https://doi.org/10.1007/978-3-662-45064-2_24

Springerpflege

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