Thromboembolic and Blood Disorders Flashcards
What is VTE in pregnancy?
Venous thromboembolism (VTE) in pregnancy refers to the formation of blood clots in the venous system, including deep vein thrombosis (DVT) and pulmonary embolism (PE), which can occur due to the hypercoagulable state of pregnancy.
What is the incidence of VTE in pregnancy?
VTE complicates approximately 1 in 1,000 pregnancies.
What are the major risk factors for VTE in pregnancy?
Personal or family history of VTE.
Obesity (BMI >30).
Age >35 years.
Multiple pregnancy.
Prolonged immobility (e.g., bed rest).
Cesarean section.
Smoking.
Thrombophilia (e.g., factor V Leiden, antiphospholipid syndrome).
Pre-eclampsia.
Dehydration or hyperemesis gravidarum.
The hypercoagulable state of pregnancy is primarily due to an increase in _____________.
Pro-coagulant factors (e.g., fibrinogen).
What are the clinical features of deep vein thrombosis (DVT) in pregnancy?
Unilateral leg swelling.
Pain and tenderness (usually in the calf).
Erythema and warmth over the affected area.
Dilated superficial veins
What are the clinical features of pulmonary embolism (PE) in pregnancy?
Dyspnoea (shortness of breath).
Pleuritic chest pain.
Cough (may be dry or with hemoptysis).
Tachycardia.
Tachypnoea.
Hypoxia (low oxygen saturation).
Syncope in severe cases.
What are the recommended investigations for suspected DVT in pregnancy?
Compression Doppler ultrasound (first-line).
D-dimer: Not routinely used, as levels are normally raised in pregnancy.
What investigations are used for suspected PE in pregnancy?
CT pulmonary angiography (CTPA): Gold standard.
Ventilation-perfusion (V/Q) scan: Alternative if CTPA is contraindicated.
The first-line imaging investigation for suspected DVT in pregnancy is _____________.
Compression Doppler ultrasound.
How is VTE managed in pregnancy?
Low molecular weight heparin (LMWH): First-line treatment.
Does not cross the placenta.
Example: Enoxaparin.
Continue LMWH for the remainder of pregnancy and at least 6 weeks postpartum (minimum duration: 3 months total).
What are the contraindications to LMWH in pregnancy?
Active bleeding.
Thrombocytopenia.
Allergy to heparin.
Severe renal impairment.
Match the anticoagulant to its safety in pregnancy:
Warfarin
LMWH
Aspirin
A: Safe in pregnancy.
B: Teratogenic; contraindicated in pregnancy.
C: Used for specific high-risk cases (e.g., antiphospholipid syndrome).
1 → B
2 → A
3 → C
How can VTE be prevented in pregnancy?
Risk assessment at the first antenatal visit and postpartum.
Early mobilization after delivery or surgery.
Use of graduated compression stockings.
Prophylactic LMWH for high-risk women (e.g., those with thrombophilia or history of VTE).
True/False
Q: LMWH is the preferred treatment for VTE in pregnancy because it crosses the placenta and has minimal fetal effects.
False (LMWH does not cross the placenta).
A 28-year-old pregnant woman presents with unilateral leg swelling and tenderness at 24 weeks. Doppler ultrasound confirms a left-sided DVT. What is the appropriate management?
Start therapeutic LMWH, monitor symptoms, and continue treatment for the rest of pregnancy and at least 6 weeks postpartum (minimum duration: 3 months).
How is VTE managed postpartum?
Continue LMWH for at least 6 weeks postpartum.
Consider switching to warfarin if long-term anticoagulation is needed (safe during lactation).
How long is VTE prophylaxis continued in high-risk women postpartum?
At least 6 weeks postpartum.
What are the potential complications of untreated VTE in pregnancy?
Pulmonary embolism (life-threatening).
Post-thrombotic syndrome.
Increased maternal and fetal morbidity and mortality
__________ is the most common direct cause of maternal death in the UK.
Pulmonary embolism.
A patient on LMWH develops significant bleeding during labor. What is the management?
Discontinue LMWH immediately, and consider protamine sulfate if urgent reversal is needed.
What is Rhesus disease of the newborn?
Rhesus disease, also known as hemolytic disease of the newborn (HDN), occurs when maternal antibodies attack fetal red blood cells due to Rh incompatibility between the mother and fetus.
Rhesus disease typically occurs when an Rh-___ mother carries an Rh-positive fetus.
negative
What causes maternal sensitization in Rhesus disease?
Sensitization occurs when fetal Rh-positive red blood cells enter the maternal circulation, leading to the production of anti-D antibodies
True/False: Rhesus disease can only occur during the first pregnancy
False. It usually affects subsequent pregnancies after sensitization has occurred
