Venous Thromboembolism in Pregnancy Flashcards
Risk factors for VTE in pregnancy
Smoking
Parity ≥ 3
Age > 35 years
BMI > 30
Reduced mobility
Multiple pregnancy
Pre-eclampsia
Gross varicose veins
Immobility
Family history of VTE
Thrombophilia
IVF pregnancy
When should prophylaxis for VTE be started
28 weeks if there are 3+ risk factors
First trimester if there are 4+ risk factors
When should VTE prophylaxis be given without the presence of risk factors
Hospital admission
Surgical procedures
Previous VTE
Medical conditions such as cancer or arthritis
High-risk thrombophilias
Ovarian hyperstimulation syndrome
VTE Prophylaxis
Subcut LMWH throughout the antenatal period and 6 weeks postnatally
When is a VTE risk assessment performed
At the booking clinic and after birth
When is VTE prophylaxis temporarily stopped
When the woman goes into labour
When should VTE prophylaxis not be restarted
Postpartum haemorrhage
Spinal anaesthesia
Epidurals
When is mechanical VTE prophylaxis given
When LMWH is contraindicated
Mechanical VTE prophylaxis
Intermittent pneumatic compression with equipment that inflates and deflates to massage the legs
Anti-embolic compression stockings
Investigations for a DVT
Doppler ultrasound
Investigations for a PE
CTPA
CXR
ECG
Risks of PE investigations
CTPA - a higher risk of breast cancer for the mother (minimal absolute risk)
VQ scan carriers a higher risk of childhood cancer for the fetus (minimal absolute risk)
Wells score with VTE in pregnancy
Not validated for use in pregnancy
D - dimer with VTE in pregnancy
Not helpful as elevated anyway
Management of massive PE and haemodynamic compromise
Immediate management, options include:
Unfractionated heparin
Thrombolysis
Surgical embolectomy
