VTE in pregnancy

Question 1

when is risk the highest

Answer 1

postpartum period

Question 2

risk factors

Answer 2

smoking
parity 3+
age >35
reduced mobility 
multiple pregnancy 
PET 
varicose veins
FHx VTE
thrombophilia
IVF pregnancy

Question 3

guidelines for starting prophylaxis

Answer 3

from 28wks if 3 risk factors

from first trimester if 4+ risk factors

Question 4

what is given for prophylaxis

Answer 4

LMWH e.g. enoxaparin, dalteparin

Question 5

how long is prophylaxis given

Answer 5

from ASAP/28wks depending how risk

continued throughout antenatal period
given 6wks postnatally

temporalily stopped when woman goes into labour and can be started right after delivery (exepct PPH, epidural)

Question 6

Ix - DVT

Answer 6

doppler USS

repeat negative USS on day 3 and 7 if still high index of suspicion

Question 7

Ix - PE

Answer 7

CXT
ECG

then
CTPA or V/Q scan

Question 8

pt with suspected DVT and PE

Answer 8

do doppler USS

if DVT present no not require a VQ or CTPA to confirm PE

Question 9

Mx of VTE in pregnancy

Answer 9

LMWH

Question 10

Mx - after VTE

Answer 10

LMWH continued remainer of pregnancy plus 6wks postnatally

or 3mo in total (whichever is longer)

Question 11

Mx if massive PE and haemodynamic compromise

Answer 11

unfractionated heparin
thrombolysis
surgical embolectomy