Complicated Pregnancy 5

Question 1

Pregnancy is a hyper-coagulable state to protect mother against bleeding post-delivery. What physiological factors contribute to it? [3]
Think of Virchow’s triad

Answer 1

• Changes in blood constituents
• Increased stasis due to progesterone and enlarging uterus
• Vascular damage mostly at delivery/c-section

Question 2

What changes in blood constituents occur in pregnancy? Increased [4], decreased [1]

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? [11]

Answer 3

Older women with a high parity
High BMI women, immobility
Smokers, IVDA
Dehydration - hyperemesis

Women with:

• Sickle Cell
• Infections
• Pre-eclampsia
• Thrombophilia
• HTN
• Homocystienuria

H/o VTE or FH

Operative delivery or prolonged labour
Haemorrhage >2L

Question 4

VTE 2 types: DVT [2] and PE [5]

How might a VTE present?

Answer 4

DVT:

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

PE:

• SOB, pain on breathing (pleuritic chest pain)
• Cough, haemoptysis
• Tachycardia
• Hypoxia
• Pleural rub, RHF

Question 5

How can we prevent VTE in pregnancy?
3 conservative mx techniques
Rx [1]

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? [4]

Answer 6

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

Question 7

How is VTE treated?

Answer 7

ANTI COAGULANTS i.e. LMWH

Question 8

What is homan’s sign

Answer 8

on forced dorsiflexion of foot, homan’s sign is positive if there is pain - indicative of DVT