1.13 Venothromboembolism and Pregnancy

Question 1

List Peripartum Risk factors VTE during preg

Answer 1

1. Pre Existing
2. Obstetric
3. Reversible causes

Question 2

1. Pre existing

Answer 2

1. Previous VTE
2. Thrombophilia
   Antithrombin deficiency / Pro C / S
   F V leidnen mut / APLipid syndrome
3. Medical comorbs
   CVS / Resp / SLE / Cancer / IBD
4. Age >35years
5. Obesity BMI>30
6. FH VTE
7. Smoking
8. Significant VV
   Symptomatic / phlebitis / skin changes
9. Paraplegia

Question 3

2. Obstetric

Answer 3

Multiple gestation
Assitsted repro tech

2. Multip
3. PET
4. Peripartum surgery
   - Appendix / lap chole
5. Prolonged labour
6. Forceps
7. CSection
8. PPH

Question 4

3. Reversible causes

Answer 4

1. Hyperemesis
2. Dehydration
3. Ovarian hyperstimulation
4. Admission / Immobility
   >3d bed rest
   Symphisis pubis
5. Systemic infection
   Abx / admission
   pneumonia
6. long distance travel

Question 5

Antenatal assessment and management

Answer 5

1. Pre preg counselling
   Prospective management plan prophylaxis
   r/f obs or haematologist w/ obs interest
2. Prev VTE
   Test thrombophilia
3. Antenatal Proph begin early in preg as possible
4. LMWH
   choice
   dose based on weight

Question 6

Antenatal assessment and management

Answer 6

Offered to:
>3 risk factors
Women w/ previous recurrent VTE
Preg VTE 
FH VTE 1st degree relative

Antithrombin deficiency>1 thrombophilia defect

Women w/ asympto inherited or acquired throbophilia
closely monitored

Question 7

Post natal Thromboprophylaxis recommendations

Answer 7

1. All women reassessed post delivery for RF
2. All women encouraged to mobilise during post partum period
3. Avoid dehydration
4. > 3 RF graduated compression stocking + LMWH
5. Warfarin and LMWH safe breastfeeding
6. Repeatedly assess RF - VTE
   develop intercuirrent prob
   or require surgery / readmission

Question 8

Post natal Thromboprophylaxis recommendations

LMWH

Answer 8

Consider 1/52 post delivery in

1. Women >2 risk factors
2. BMI >40
3. Emergency section
4. Elective section >1 additional RF
5. All woman asympto heritable / acquired thrombophilia
   even if not receiving antenatal prophylaxis
   extend to 6/52 if RF

Question 9

Post natal Thromboprophylaxis recommendations

Answer 9

1. Women with a past history of VTE
   prior to current pregnancy
2. Recieving LMWH antenatally
   if long term warfarin - restart when risk haemorrhage low
3. Additional persistent risk factors
   >7 days post partum
   Prolonged admission / wound infection