الفهرس 
PHYSIOLOGICAL CHANGES IN PREGNANCYOnly 14 pages are availabe for public view
 |  | from | 98 |  |  |
| | | from | 98 | | |
Abstract
P
regnancy produces profound physiological changes that alter the usual response to anesthesia, many of these changes are useful to the mother in tolerating the stresses of pregnancy and delivery.
Pregnancy is a period of increased risk of thrombotic complications, owing to hypercoagulability, venous stasis, and vascular damage (the three elements of Virchow’s triad).
Venous thromboembolism is among the leading causes of maternal death in developed countries. Modern care has dramatically reduced the risk of maternal death from hemorrhage, infection, and hypertension, but rates of morbidity and death from thrombosis have remained stable or increased in recent years.
Awareness of deep vein thrombosis and pulmonary embolism is the best way to prevent it. Although preventing venous thromboembolism is more difficult than its treatment, it remains more effective than waiting for DVT to develop.
Heparins, especially LMWHs, are the main anticoagulants used in pregnancy. Dosing depends on the clinical indications and on the agent selected.
Treatment with anticoagulants during pregnancy must therefore be carefully considered, with judicious selection of the agent, and with reflection on the physiologic changes of pregnancy to ensure appropriate dosing.
In preoperative assessment of the patient undergoing labor recent coagulation profile and platelet count are needed. So in case of an emergency cesarean section in patient receiving heparin for more than 4 days because heparin-induced thrombocytopenia (HIT) may occur in patients receiving heparin for greater than four days, and no time to asses platelet count prior to neuraxial block, it can be proceeded with general anesthesia.
Meticulous intraoperative monitoring is important for early diagnosis of pulmonary embolism.
Postoperative intensive care unit (ICU) is needed for postoperative monitoring especially if the patient is hemo-dynamically unstable or intraoperative showering of pulmonary embolism has occurred.
Anticoagulation is essential in the postpartum period, as the puerperium is the period of highest risk of thromboembolic events, about one-third of pregnancy-associated events occur during these 6 to 12 weeks. But heparin should be resumed 6 to 12 hours after delivery, once hemostasis is confirmed.