Thromboembolic disease

Question 1

Physiological changes

Answer 1

Reduced fibrinolytic activity
Increased certain clotting factors: FVIII, IX, X, FI (fibrinogen)
Protein S and AT levels decrease
Venous stasis due to vasodilation, decreased flow

Question 2

VTE risks

Answer 2

Antenatal
Previous VTE
Genetic thrombophilia
Acquired thrombophilia
Age >35
Inflammatory conditions
Obesity
Parity
Smoking
Varicose veins
Multiple pregnancy

Intra-partum
Decreased mobility
CS
PET
SB
Operative delivery
PPH

Transient eg infection, OHSS etc

Question 3

Thrombophilias

Answer 3

AT deficiency
Protein C & S deficiency
FVL (homo vs heterozygous)
Prothrombin gene mutation

Pregnancy risks
Miscarriage, PTB, abruption, PET, IUGR, SB
Worsening VTE risks

Question 4

CTPA/V/Q scan

Answer 4

VQ scan
- Less available
- Less helpful for other diagnosis
- More fetal radiation (childhood cancer) but less maternal breast exam

CTPA
- More breast radiation especially PP