Annales françaises d'anesthèsie et de rèanimation
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Pulmonary embolism remains a leading cause of maternal death in France and in other developed countries. Prevention is well codified, but management remains complex both for diagnosis and therapeutics. The objective of this review was to update the knowledge on diagnosis and treatment of pulmonary embolism during pregnancy. ⋯ Diagnostic approach is first based on the use of ultrasound- Doppler, and frequently on-to computed tomographic pulmonary angiography or ventilation-perfusion lung scanning. The treatment is based on low molecular weight heparin. Others therapeutics, such as thrombolysis or temporary vena cava filter, may be useful in certain circumstances.
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Each year in France 6000 to 9000 patients are splenectomised or spleen embolized. As spleen has immunological functions, it contributes to protect against infections. Thus, hypo or asplenia increase the risk of infection, especially the risk of Overwhelming Post-Splenectomy Infection (OPSI). ⋯ Yearly, patients must receive Influenza vaccination. As an interindividual variation exists in vaccinal response, measurement of serotype-specific antibodies can be used, if available, to individualized risk patients and to organize revaccination. Finally, to prevent OPSI, patient and next-of-kin must be educated about prevention measures and infectious risk to optimize patient's compliance.