Complicated Pregnancy 2- VTE

Question 1

You should know Virchow’s triad by now:

• Hypercoagubility
• Venous stasis
• Vascular Injury

That leads to clots. How do these come about during pregnancy?

Answer 1

• Stasis cos big heavy belly etc.
• Vascular damage mostly at delivery/c-section
• Hypercoagulation as physiological protection against haemorrhage during/post delivery

Question 2

So pregnancy is a hypercoagulable state so women don’t all die in childbirth. How does this come about?

Answer 2

Increased:

• Fibrinogen
• Factor VIII
• VW Factor
• Platelets

Decreased Anti-coagulants like Antithrombin III

Question 3

What women are at particular risk of VTE during pregnancy?

Answer 3

• Older women with a high parity
• High BMI women
• Smokers & IV drug users
• Immobile women
• Dehydration

Women with:

• Sickle Cell
• Infections
• Pre-eclampsia

H/o VTE, thrombophilia or FH

• Operative delivery or prolonged labour
• Haemorrhage >2L

Question 4

How might a VTE present?

Answer 4

VT:

• Pain in calf and tender muscle
• Increased girth &redness of calf

PE:

• SOB & Pain on breathing
• Cough
• Tachycardia
• hypoxia
• Pleural rub

Question 5

How can we prevent VTE in pregnancy?

Answer 5

TED stockings
Hydration & mobility

If they have 3 or more risk factors we can use prophylactic anti-coagulation up to 6wks post-partum

Question 6

What tests can we do if we suspect a vTE?

Answer 6

ECG
Blood Gases

Doppler US
V/Q scan
CT Pulm. Angiogram (CTPA)

Question 7

How is VTE treated?

Answer 7

ANTI COAGULANTS i.e. LMWH

not warfarin: teratogenic