Complicated Pregnancy 5

Question 1

This deck will be very short

Answer 1

Just covers VTE

Question 2

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 2

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

Question 3

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

Answer 3

Increased:

• Fibrinogen
• Factor VIII
• VW Factor
• Platelets

Decreased Anti-coagulants like Antithrombin III

Question 4

What women are at particular risk of VTE during pregnancy?

Answer 4

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

Women with:

• Sickle Cell
• Infections
• Pre-eclampsia

H/o VTE, thrombophilia or FH

Operative delivery or prolonged labour
Haemorrhage >2L

Question 5

How might a VTE present?

Answer 5

VT:

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

PE:

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

Question 6

How can we prevent VTE in pregnancy?

Answer 6

TED stockings
Hydration & mobility

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

Question 7

What tests can we do if we suspect a vTE?

Answer 7

ECG
Blood Gases

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

Question 8

How is VTE treated?

Answer 8

ANTI COAGULANTS i.e. LMWH