VTE in pregnancy

Question 1

Why is there an increased risk of VTE in pregnancy?

Answer 1

It is a hypercoagulable state

Question 2

Risk factors for VTE in pregnancy

Answer 2

Smoking 
BMI>30
Parity >3
Age>35 
(Family) history of VTE
Multiple pregnancy
Reduced or immobility
Pre-eclampsia
Thrombophilia - ask about clotting disorders

Question 3

When to start VTE prophylaxis and what to give

Answer 3

From 28 weeks if 3 risk factors - high risk
First trimester if 4 or more risk factors - very high risk

LMWH e.g. enoxaparin

Prophylaxis is temporarily stopped when the woman goes into labour, and can be started immediately after delivery (except with postpartum haemorrhage, spinal anaesthesia and epidurals).

Question 4

Investigations if suspect DVT/PE

Answer 4

DVT - doppler ultrasound

PE - CXR, ECG and either CTPA or VQ scan to establish a definitive diagnosis

CT pulmonary angiogram involves a chest CT scan with an intravenous contrast that highlights the pulmonary arteries to demonstrate any blood clots.

Ventilation-perfusion (VQ) scan involves using radioactive isotopes and a gamma camera, to compare the ventilation with the perfusion of the lungs.

Question 5

Management of diagnosed VTE i.e. a DVT or PE

Answer 5

LMWH e.g. enoxaparin, dalteparin

Given immediately and continued for the rest of the pregnancy plus 6 weeks after (or for a total of 3m - whichever is longer)

Massive PE and haemodynamic compromise:

• Is life threatening
• Treatment options include - unfractionated heparin, thrombolysis, surgical embolectomy