VTE and PE Flashcards
Define thrombosis
A blood clot in part of the circulatory system
What is a venous thrombo-embolism?
A condition in which a blood clot forms (most often in
the deep veins of the leg, groin or arm (DVT)) and
travels in the circulation, lodging in the lungs (PE)
What is a pulmonary embolism (PE)?
A fragment of a blood clot in a blood vessel in the lungs
At what rate do VTE’s occur during pregnancy and in the postnatal period?
1 in 1000. Risk increases significantly (up to 50%) in the PN period.
Why is there an increased risk of VTE in pregnancy/ during the PN period?
- Hypercoagulation occurs in the third trimester
-Progesterone increase causes a reduction in venous tone which can cause stasis of blood.
-Increased factor VII and fibrinogen
-Pressure of gravid uterus on inferior vena cava and pelvic
veins.
-Increased diuresis following delivery/ haemodilution
reversal
When should a VTE risk assessments be performed?
- At booking
- At any antenatal admission
- Intrapartum
- Immediately postpartum
A woman who has experienced any previous VTE (other than a single event related to major surgery) will be deemed high risk and require…
Antenatal prophylaxis with low molecular weight heparin (LMWH). Referral to specialist also needed.
Name the risk factors that pose an ‘intermediate risk’ and may require a woman to need antenatal prophylaxis when completing a VTE risk assessment.
- Hospital admission
- Prev VTE related to major surgery
- High risk thrombophilia with no VTE
- Medical comorbidities (cancer, heart failure, sickle cell disease…)
- Any surgical procedure
- OHSS (ovarian hyperstimulation syndrome- treatment for infertility/ivf preg) in first trimester only.
How many of the following must be present for LMWH to be advised/prescribed antenatally?
- obesity (BMI >30)
- age >35
- parity 3 or >
- smoker
- gross varicose veins
- pre-eclampsia
- immobility
- family history of unprovoked VTE in first deg relative
- IVF/ART
- low risk thrombophilia
- multiple pregnancy
Four. If three or more, antenatal prophylaxis advised from 28/40,
What transient risk factors are there for the development of a VTE?
- Hyperemesis/dehydration
- Long distance travel
- Current systemic infection
What advice should be given to low risk women to reduce their risk of developing a VTE?
-Maintain mobilisation and hydration
What increases the risk of developing a VTE?
- Lifestyle (age, bmi, smoking status)
- Pregnancy morbidities (CV disease, diabetes, hypertension)
- Pregnancy complications (Preeclampsia, gestational diabetes, APH etc)
- Delivery complications (stillbirth, PPH, postpartum infection, preterm birth)
What are the symptoms of a DVT?
◦ Painful swollen leg
◦ Redness/ oedema of the leg (85% occur in the left leg)
◦ Left illiac fossa/ groin/ buttock pain
◦ Non-specific lower abdominal pain
◦ Usually unilateral but can be bilateral
What are the symptoms of a PE?
◦ Sudden onset chest pain ◦ Sudden onset breathlessness ◦ Dizziness ◦ Syncope (loss of consciousness and drop in BP) or collapse ◦ Tachycardia ◦ Hypoxia ◦ Coughing (may be bloody)
DVT’s/PE’s are more likely to occur among the black population than the caucasian population at what percentage…
30-60%. It’s important to listen carefully to any symptoms that may be experienced and not to rely on visual assessments.
