Читать книгу Assisted Reproduction Techniques - Группа авторов - Страница 80

Challenge: The patient with thrombosis risk or thrombophilia.

Background:

 DVT occurring after IVF is a rare but potentially life‐threatening complication of IVF.

 Considerable changes in the coagulation and fibrinolytic systems are observed following hCG administration.

 OHSS is a major risk factor in developing VTE in all patients undergoing ART.

Management:

 All patients beginning IVF should be subject to an individual risk assessment prior to commencing treatment.

 Screening for thrombophilias should be considered in women who have had a previous thrombotic event or a family history of thrombosis, and maybe in women who have developed OHSS.

 Thromboprophylaxis should be considered in women with a previous DVT, women who develop moderate to severe OHSS and in women with a thrombophilia. In addition, women who develop serious infections or immobilization should receive thromboprophylaxis.

 Compression stockings and low‐molecular weight heparin constitute first line thromboprophylaxis.

 Thromboprophylaxis should normally commence 24 hours after oocyte retrieval to reduce the risk of hemorrhagic complications. This should be extended throughout the first trimester. In cases where thrombophilia has been detected, consideration should be given to extending prophylaxis throughout pregnancy.

Prevention: Judicious employment of methods to prevent OHSS, especially in high‐risk patients.