VTE in pregnancy Flashcards
What are the risk factors for VTE in pregnancy?
Smoking
Parity > 3
Age > 35 years
BMI > 30
Reduced mobility
Multiple pregnancy
Pre-eclampsia
Gross varicose veins
Immobility
Family history of VTE
Thrombophilia
IVF pregnancy
When should VTE prophylaxis be started?
At 28 weeks if there are three risk factors
In the first trimester if there are 4 or more risk factors
What other situations would prophylaxis be considered in?
Hospital admission
Previous VTE
Surgery
Cancer
Ovarian hyperstimulation syndrome
What medicaiton is used in VTE prophylaxis?
LMWH (low molecular weight heparin)
How long is VTE prophylaxis continued after delivery?
6 weeks
What are the mechanical VTE prophylaxis options?
Anti-embolic compression stockings
Intermittent pneumatic compression
What is the presentation of DVT?
Unilateral
Calf or leg swelling
Dilated superficial veins
Tenderness to the calf
Oedema
Redness
What is the presentation of PE?
Shortness of breath
Cough
Haemoptysis
Pleuritic chest pain
Hypoxia
Tachycardia
Raised resp rate
Low grade fever
What is the investigation of choice for DVT?
Doppler ultrasound
What are the investigations used in the diagnosis of PE?
CXR
ECG
What is the definitive diagnosis of PE?
CTPA - CT pulmonary angiography
What types of anticoagulants should be avoided in pregnancy?
Warfarin and DOACs
Why is DVT more common in the left leg in pregnancy?
The gravid uterus puts pressure on the left iliac vein crossing the left iliac artery -slows venous return
