VTE in Pregnancy Flashcards
What is venous thromboembolism (VTE)?
VTE refers to the formation of a blood clot in a vein, encompassing both deep vein thrombosis (DVT) and pulmonary embolism (PE).
Why is pregnancy a risk factor for VTE?
Pregnancy is a hypercoagulable state due to increased clotting factors, reduced anticoagulants, and venous stasis from uterine compression.
When is the risk of VTE highest during pregnancy and the puerperium?
The risk is highest in the postpartum period, particularly in the first 6 weeks after delivery.
What are the risk factors for VTE in pregnancy?
Risk factors include obesity, advanced maternal age, immobility, thrombophilia, previous VTE, multiple pregnancy, and caesarean section.
What are the common symptoms of deep vein thrombosis (DVT)?
Symptoms include unilateral leg swelling, pain, redness, and tenderness, often in the calf.
What are the common symptoms of pulmonary embolism (PE)?
Symptoms include sudden onset of dyspnoea, chest pain (pleuritic), tachycardia, and haemoptysis.
How is VTE diagnosed during pregnancy?
Diagnosis involves clinical assessment, D-dimer (with caution), compression ultrasound for DVT, and CTPA or V/Q scan for PE.
Why is D-dimer interpretation challenging in pregnancy?
D-dimer levels are naturally elevated in pregnancy, reducing its specificity for diagnosing VTE.
What imaging is used for suspected DVT in pregnancy?
Compression ultrasound is the first-line imaging modality.
What imaging is used for suspected PE in pregnancy?
CT pulmonary angiography (CTPA) or ventilation/perfusion (V/Q) scanning can be used, depending on availability and maternal risk factors.
What is the first-line treatment for VTE in pregnancy?
Low-molecular-weight heparin (LMWH) is the first-line treatment as it is safe for the fetus and effective for the mother.
Why is warfarin contraindicated in pregnancy?
Warfarin is teratogenic and can cause fetal complications, such as fetal warfarin syndrome.
How is the dose of LMWH determined in pregnancy?
The dose is based on maternal weight at the time of diagnosis.
How long should anticoagulation be continued after a VTE in pregnancy?
Anticoagulation is continued for at least 6 weeks postpartum, with a minimum total duration of 3 months.
What are the contraindications for LMWH in pregnancy?
Contraindications include active bleeding, severe thrombocytopenia, and hypersensitivity to heparin.
How is VTE risk assessed during pregnancy?
Risk is assessed using a validated VTE risk assessment tool at the booking appointment and repeated if risk factors change.
What are the preventive measures for VTE in pregnancy?
Preventive measures include early mobilisation, hydration, compression stockings, and prophylactic LMWH in high-risk women.
When is prophylactic LMWH indicated in pregnancy?
Indications include a history of previous VTE, known thrombophilia, or multiple risk factors for VTE.
What are the side effects of LMWH?
Side effects include bleeding, bruising at the injection site, and, rarely, heparin-induced thrombocytopenia (HIT).
How is LMWH administered in pregnancy?
LMWH is given as a subcutaneous injection, typically once or twice daily, depending on the regimen.
What are the complications of untreated VTE in pregnancy?
Complications include progression to pulmonary embolism, maternal morbidity, and, in severe cases, maternal or fetal death.
What is the role of thrombophilia testing in VTE?
Thrombophilia testing is considered in women with recurrent VTE or a family history of thrombophilia.
How is VTE managed during labour and delivery?
LMWH is stopped 24 hours before planned delivery; regional anaesthesia is contraindicated within 12 hours of the last prophylactic LMWH dose.
When is postpartum thromboprophylaxis recommended?
Postpartum thromboprophylaxis is recommended for women with a history of VTE, high-risk thrombophilia, or multiple risk factors.
How is VTE in pregnancy monitored?
Monitoring includes regular clinical review, assessment of anti-Xa levels in certain cases, and adjustment of LMWH dosage if required.
What lifestyle advice is given to reduce VTE risk in pregnancy?
Advice includes staying active, avoiding prolonged immobility, maintaining a healthy weight, and staying hydrated.
