VTE

Question 1

Definition

Answer 1

Blood clot that partially or fully excludes a vein most commonly in the leg. This is know as DVT.

Question 2

Physicology

Answer 2

Haemolysis is the natural function of body repair. Platlets and fibrin form a clot to repair the endothelial damage.

Question 3

Virchows triad

Answer 3

Hyprrcoagulabilty: the constituents of blood change in pregnancy to deal with the potential blood loss and increase volume. Also pre existing clotting disorders
Circulatory stasis: veins are relaxed from progesterone and then immobility in labour and postnatal increases the risk of a clot formation.

Endothelial damage: due to trauma such as c/s, instrumental delivery, baby travellinf through the pelvis and gravid uterus on the vessels.

Question 4

Existing VTE risks

Answer 4

Age 35
BMI 30
Smoking 
Diabetes
Pre eclampsia 
History VTE
Varicose veins 
SLE
Medical comorbidities

Question 5

Obstetric risks

Answer 5

C/s
Prolonged Labour 
Epidural 
Instrumental 
Multiple pregnancy 
IVF
Hyperemisis

Question 6

Symptoms

Answer 6

Leg swelling raised temperature
Area hot to touch 
Fever 
Redness 
Sore 
PE: hypotension
Breathlessness 
Chest pain 
Cough

Question 7

Diagnosis

Answer 7

DVT: dopplar on the vein
MRI
D Dimers 
PE: chest xray
ECG

Question 8

Treatment

Answer 8

Low weight molecular heparin : safe through pregnancy and breast feeding but must stop for labour.
Warfrin not safe in first trimester or towards the end.

Dalteparin and aspirin
All drugs titrated to weight and length of time must be established.

TEDS
Mobilisation and hydration