Complicated Pregnancy - 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 (protects against bleeding post-delivery). How does this come about?

Answer 2

• Increase in fibrinogen, factor VIII, VW factor, platelets
• Decrease in natural anticoagulants – antithrombin III
• Increase in fibrinolysis

Question 3

What women are at particular risk of VTE during pregnancy?

Answer 3

• Older women with a high parity
• High BMI women
• Smokers and 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 and redness of calf

PE:

• SOB and pain on breathing
• Cough
• Tachycardia
• Hypoxia
• Pleural rub

Question 5

How can we prevent VTE in pregnancy?

Answer 5

• TED stockings
• Hydration and mobility I
• f 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