Thromboembolic disorders

Question 1

What is the leading cause of mortality and serious morbidity in pregnant women?

Answer 1

Thromboembolism

Question 2

The risk of thromboembolic events during pregnancy increases how much during pregnancy

Answer 2

10 fold!!

Question 3

Why does pregnancy increase thromboembolic risk?

Answer 3

Pregnancy contributes to Virchow’s Triad:

• Venous stasis of the lower limbs due to enlargement of the Uterus compressing the IVC and pelvic veins
• Also hormones lead to increased vein capacitance (smooth muscle relaxation) which also contributes to stasis
• Increased progesterone increases decidual and hemostatic systems
• Fibrinogen levels double
• Increases in factors 7,8,9,10, 12
• vWF up
• Decrease in protein C and S

Question 4

Look at risk factors

Answer 4

ok

Question 5

Antiphospholipid Antibody Syndrome

Answer 5

Responsible for 14% of Thromboembolic disease in pregnancy

Question 6

What are the criteria for diagnosing anti-phospholipid antibody syndrome

Answer 6

Presence of prior or current VTE/ characteristic obstetric complications AND
At least one lab criterion which can be: anticardiolipin antibodies or lupus anticoagulant. These lab tests must be present on at least 2 occasions

Question 7

Most important modifier when investigating for the presence of inherited thrombophilias

Answer 7

personal or family history

Question 8

Treatment

Answer 8

Unfractioned heparin

Question 9

Unfractioned heparin side effects?

Answer 9

May cause osteoporosis KNOW
May cause hemorrhage
May cause thrombocytopenia (HIT) usually occurs in first 7 days