PRE pregnancy advice 28yr old with h/0 thromboembolism HB 79

Question 1

HX

Answer 1

-Previous DVT, when , how, loacation
-TX : IV heparin 2/52>followed by warfarin 6/12, now no tt
CONTRACEPTION
-using condoms, ocp prior to 1st pregnancy
H/O DVT
H/O trauma, sx legs pelvis
SOB now, varicose veins, ankle edema
PREVIOUS DELIVERY
-weight, mode
FAMILY HX
Any IX done after ? not done

Question 2

MX?

Answer 2

-should be managed with obgyn and physician
IX
-anticardiolipin ab, protein C./s, lupus anticoagulant, factor laden V.
MX
-if thrombophilia >antocoag throughout preganncy and and puerperium
-even if not start at 14weeks and ct puerperium
ANTICOAG
-sc low dose heparin 7500 bd/LMWH20-40 bd
-warfarin usually not used in pregnancy due to 5% tertogenous in 1st trimester, increase miscarriage, maternal hemoorhage , still birth,
-but used if tx postpartum

Question 3

ADVICE

Answer 3

-avoid prolonged immobilisation during pregnancy
-use compression stockings by day pregnancy
-deliver controlled manner38-39, although hepain not full dose and unlikely to affect clotting test>best to arrange indcution so mornin gdose can be with held
-take folic acid