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MRCOG Antenatal Part 2 Revision - Hay > Reducing risk VTE pregnancy and puerperium GTG > Flashcards

Reducing risk VTE pregnancy and puerperium GTG Flashcards

1
Q

Was is the AN risk of VTE?

A

1.3/10,000

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2
Q

What is the postpartum risk of VTE?

A

1-2/1000

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3
Q

List the minor AN risk factors:

A

Obesity BMI >30
Age >35
Parity > 3
Gross varicose veins
Immobility (paraplegia, PGP)
Fix unprovoked VTE in 1st degree relative
Multiple pregnancy
Low risk thrombophilia (
IVF/ART

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4
Q

How many minor risk factors should be present to consider prophylaxis from 28 weeks?

A

3

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5
Q

How many minor risk factors should be present to consider prophylaxis from 1st trimester?

A

4

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6
Q

What are the intermediate AN risk factors?

A

Hospital admission
Single previous VTE related to major surgery
High risk thrombophilias + no VTE
Medical co-morbidity
Any surgical procudure
OHSS

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7
Q

If any one intermediate RF present?

A

Consider AN prophylaxis

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8
Q

Which medical conditions are listed?

A

Cancer
Heart failure
Active SLE/IBD/inflammatory polyarthropathy
Nephrotic syndrome
T1DM with nephropathy
Sickle cell disease
Current IVDU

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9
Q

What are considered low risk thrombophlias

A

Heterozygous for factor V leiden, prothrombin G20210A mutations.

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10
Q

What are considered high risk thrombophilias

A

Anti-thrombin deficiency
Protein C or S deficiency
Compound/homozygous for low risk thrombophilias

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11
Q

What are high risk factors for AN VTE?

A

Previous VTE (except single event related to surgery)

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12
Q

What transient RF should be consider when calculating VTE?

A

Dehydration/hyperemsis, infection, long distance travel (equal or > 4hrs)

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13
Q

What are the single risk postpartum risk factors?

A

Age > 35
BMI >30 <40
Parity equal >3
Smoker
ELCS
Fhx VTE
Low risk thrombophilia
Immobility
Current PET
Multiple preg
Preterm delivery <37weeks
Stillbirth in this pregnancy
Mid cavity/rotational delivery
Prolonged labour >24 hrs
PPH > 1 L or blood transfusion

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14
Q

What are the PN intermediate risk factors (2 points)

A

CS in labour
BMI > 40
Readmission or prolonged (>3 days) to hospital
Any surgical procedure in puerperium (except immediate perineal repair)
Medical co-morbidity

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15
Q

What are the PN high risk factors?

A

Any previous VTE
AN LMWH
High risk thrombophilia
Low risk thrombophilia + FHx

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16
Q

When is 10 days LMWH given in PN period

A

2+ minor risk factors
Any intermediate RF

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17
Q

When is 6 weeks LMWH given in PN period?

A

If persisting to > 3 risk factors
High risk factor present

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18
Q

Recurrence rate of previous VTE not related to surgery?

A

2-11%

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19
Q

If previous VTE and anti-thrombin deficiency?

A

From 1st trimester until 6 weeks PN higher dose LMWH 50-75% full dose (until PO anticoagulation is restarted), consider anti-Xa monitoring

20
Q

What is target anti X-a levels previous VTE?

A

4 hour peak 0.5-1.0 iu/ml

21
Q

If previous VTE and other inheritable thrombophilia?

A

Same dose

22
Q

What other VTE conditions should higher dose LMWH in pregnancy been considered

A

Anti-thrombin deficiency
Anti-phospolipid syndrome
Recurrent VTE

23
Q

If unprovoked/oestrogen realated VTE, when to commence LMWH

A

1st trimester

24
Q

If provoked VTE (after surgery) and no other RF< when to commence LMWH

A

28 weeks

25
Q

Women who have an unprovoked VTE should be tested for which condition?

A

APS

26
Q

Women with what Family Hx should be considered for thrombophilia screening?

A

Unprovoked/oestrogen related VTE in 1st degree < age 50

27
Q

Do you need to treat homozygous MHTFR in pregnancy?

A

No not associated with VTE in pregnancy

28
Q

What % of AN VTE occurs before 15 weeks?

A

40-50%

29
Q

How long should we wait to given regional anaesthetic following last dose of prophylactic dose LMWH?

A

12 hours

30
Q

When can prophylactic LMWH be given after spinal or epidural catheter removed?

A

4 hours

31
Q

How long should we wait to given regional anaesthetic following last dose of treatment dose LMWH?

A

24 hours

32
Q

Relative to vaginal delivery, how much is the VTE risk increases compared to
- ELCS
- EMCS

A
  • ELCS - 2 times
  • EMCS - 4 times
33
Q

Dose of
Enoxaparin
Deltaparin
Tinzparin

If < 50kg

A

<50kg

Enoxaparin 20mg OD
Deltaparin 2500IU
Tinzparin 3500IU

34
Q

Dose of
Enoxaparin
Deltaparin
Tinzparin

If 50-90kg

A

50-90

Enoxaparin 40mg
Deltaparin 5000 IU
Tinzparin 4500IU

35
Q

Dose of
Enoxaparin
Deltaparin
Tinzparin

If 90-130kg

A

90-130kg

Enoxaparin 60mg
Deltaparin 7500IU
Tinzparin 7000 IU

36
Q

Dose of
Enoxaparin
Deltaparin
Tinzparin

If 130-170

A

130-170

Enoxaparin 80mg
Deltaparin 10,000IU
Tinzparin 9000IU

37
Q

Dose of
Enoxaparin
Deltaparin
Tinzparin

If >170

A

> 170

Enoxaparin 0.6mg/kg/day
Deltaparin 75 u/kg/day
Tinzparin 75 u/kg/day

38
Q

When to use unfractionated heparin?

A

Risk of haemorrhage or regional anaesthetics may be required

39
Q

How long must wait between UFH and regional?

A

4 hours

40
Q

Major risk of UFH?

A

Heparin induced thrombocytopenia (HIT)

41
Q

Postpartum, when can LMWH be converted to warfarin?

A

Day 5-6

42
Q

Is breastfeeding safe in warfarin?

A

yes

43
Q

What congenital abnormalities does warfarin cause?

A

Hypoplasia of nasal bridge
Congenital heart defect
Ventriculpmegalt
Agenisis corpus callous
Stippled epiphyses

Risk 5% 6-12 weeks, dose dependant

44
Q

Can NOACs be given in pregnancy or breast feeding?

A

No

45
Q

TEDS should create a compression of what pressure?

A

14-15mmHg

46
Q

What are the contraindications to LMWH?

A

Known bleeding disorder (haemophilia, von willebrands, acquired coagulopathy
Active AN/PP bleeding
Women with increased risk of major haemorrhage (praevia)
Thrombocytopenia <75
Active stroke in previous 4 weeks
Severe renal disease eGFR < 30
Severe liver disease
Uncontrolled HTN >SBP 200, >120 DBP

MRCOG Antenatal Part 2 Revision - Hay (72 decks)

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