Pregnancy complication - Venous thromboembolism

Question 1

How many risk factors for VTE would prompt consideration of VTE prophylaxis with LMWH?

Answer 1

3 or more from 28 weeks

4 or more immediate

Until 6 weeks post natal

Question 2

What are risk factors for VTE in a pregnant woman?

Answer 2

• Age > 35 years
• BMI > 30
• Parity > 3
• Smoker
• Reduced mobility
• Pre-eclampsia
• Gross varicose veins
• FH of VTE
• IVF
• Multiple pregnancy
• Assisted reproduction
• Haematological disease - Sickle cell, thrombophilia, past thromboembolism
• IVDU

There are many more than this…

Question 3

If somone was high risk for VTE, what measures would you take in managing them?

Answer 3

Antenatal thromboprophylaxis with LMWH - enoxaparin

Question 4

If someone was intermediate risk of VTE during pregnancy, how would you manage them?

Answer 4

Consider antenatal prophylaxis with LMWH

Question 5

What thromboprophylaxis is needed for women following C-section?

Answer 5

LMWH heparin for 7 days postpartum

Question 6

What LMWH is usually used as thromboprophylaxis in pregnancy?

Answer 6

Enoxaparin

Question 7

How would you manage a massive PE in a pregnant woman?

Answer 7

• Consider need for thrombolysis vs percutaneous embolectomy
• Consider LMWH - twice daily enoxaparin

Question 8

Should LMWH be continued through labour?

Answer 8

No - stop it and keep woman well hydrated

Question 9

How long should you wait until LMWH is started again following an epidural?

Answer 9

>4h

Question 10

Why is pregnancy a hypercoagulable state

Answer 10

• Raised fibrinogen, factor 7, 9, 10 and vWF, platelets
• Decrease in natrual anticoagulants - antithrombin3
• Reduced fibrinolysis