Thromboembolism

Question 1

Describe four ways in which pregnancy is a pro-thrombotic process?

Answer 1

Increased blood clotting factors
Decreased fibrinolytic activity
Increased fibrinogen activity and levels (helps form clots)
Decreased anti-thrombin and protein S

Question 2

What are the complications associated with the pro-thrombotic state of pregnancy?

Answer 2

x6 fold increased risk of VTE

Increased risk of PE

Question 3

What is the prevalence of DVT in pregnancy and where is the most commonly affected site?

Answer 3

1% - highest risk POST-natal

Occurs @ illiofemoral vein of the (L) side

Question 4

Describe three symptoms associated with DVT?

Answer 4

Pain
Swelling
Redness of affected area (calf)

Question 5

Describe the treatment of DVT within pregnancy?

Answer 5

S.C LMWH used - Tinzaparin

- Warfarin NOT used due to tetragenic effects

Question 6

Name four symptoms associated with PE?

Answer 6

Chest pain
Haemoptysis
SOB
Collapse

Question 7

Name three signs associated with PE?

Answer 7

Tachypnoea
Tachycardia
Hypoxic (low O2 sats)

Question 8

Which investigations should be carried out with a suspected PE?

Answer 8

FBC
ABG
V/Q scan
CXR - (?LRTI)

Question 9

Name 7 risk factors associated with increased risk of PE/DVT within pregnancy?

Answer 9

Age >35
Smoking
Increased BMI >30
Parity 3+
Immobility 
Multiple pregnancy
Varicose veins

Question 10

Name three conditions that will precipitate thombopillia?

Answer 10

Factor V leiden
Antiphospholipid syndrome
Protein C deficiency