Thromboembolism in pregnancy

Question 1

Define thromboembolism in pregnancy.

Answer 1

DVT: Blood clot in deep veins, usually leg

PE: Distal spread of thrombus into lung

Question 2

What is the aetiology of thromboembolism in pregnancy?

Answer 2

Virchows triad: Injury, stasis, hypercoaguablity.

Commonly deep veins of leg and pelvis and embolises to pulmonary vasculature. Pregnancy is procoagulant.

Question 3

What are risk factors of thromboembolism in pregnancy?

Answer 3

General: Maternal age, thrombophilia, obesity, personal/FHx, msmoking immobility.

Pregnancy: C-section, instrumental, infection, PREC, multiple, HEG/dehydration.

Question 4

Summarise the epidemiology of thromboembolism in pregnancy.

Answer 4

1/6000

Question 5

What are signs and symptoms of thromboembolism in pregnancy?

Answer 5

DVT: leg pain and swelling, tender hot calf.

PE: SOB, chest pain, cough , haemoptysis.

OE:

DVT: Unilateral LL ischaemia, erythema, tenderness, low grade pyrexia.

PE: General: high HR, RR, temp, reduced O2 sats, cardioresp
Chest ascultaton: normal or local reduced air entry, crepitations
Cardiovascular: low P2.

Question 6

What investigations should be performed for thromboembolism?

Answer 6

DVT: duplex USS.

PE: ABG (low O2, low CO2), ECG (sinus tachy, S1Q3T3), CXr, duplex USS. VQ scan or CTPA if high suspicion.

Bloods: FBC, U+Es, LFT, clotting, G+S.

Question 7

What is the management of thromboembolism in pregnancy?

Answer 7

Prevent: Movement, evaluate thromboprophylaxis, compression stockings, LMWH.

Treat: LMWH, initiate even only on clinical suspicion. Continue for rest of pregnanct and discontinue on labor initiaiton. Continua 6/52 postnatal.

Massive PE: ABC, MDT management, IV unfracHep. Early thrombolysis, thoracotomy or surgical embolectomy.

Question 8

What are the complications of thromboembolism in pregnancy? What is the prognosis of thromboembolism in pregnancy?

Answer 8

LT anticoagulation effects, post thrombotic leg.

PE is largest cause of maternal death in the UK.