VTE

Question 1

What is VTE in pregnancy?

Answer 1

· DVT: blood clot in deep veins, usually leg.

· PEL distal spread of thrombus into lung.

Question 2

What is the aetiology of VTE?

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 the RFs for VTE?

Answer 3

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

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

Question 4

What is the epidemiology of VTE?

Answer 4

1/6000.

Question 5

What is the Hx/ Exam of VTE?

Answer 5

DVT: leg pain and swelling, tender hot calf.

PE: SOB, chest pain, cough , haemoptysis

DVT:

· unilateral LL ischaemia, erythema, tenderness, low grade pyrexia.

PE:

· General: high HR, RR, temp, reduced O2 sats, cardioresp collapse.

· Chest ascultaton: normal or local reduced air entry, crepitations

· Cardiovascular: low P2.

Question 6

What are the Ix of VTE?

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, UE, LFT, clotting, GS.

Question 7

What is the management of VTE?

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 VTE?

Answer 8

LT anticoagulation effects, post thrombotic leg. PE is largest cause of meternal d UK.