VTE in pregnancy

Question 1

Why is VTE common in pregnancy?

Answer 1

Normal pregnancy is associated with:

• Increased blood coagulability
• Reduced thrombolysis
• Venous stasis

Question 2

What are the risk factors for VTE in pregnancy?

Answer 2

• Age>40
• Parity>3
• Smoking
• Immobility
• Pre-eclampsia
• Multiple pregnancy
• C-section
• Prolonged labour
• PPH
• Preterm
• OHSS in first trimester
• Hyperemesis

Question 3

How should VTE be treated?

Answer 3

LMWH (Enoxaparin) for a minimum of 6 months or until 6 weeks postnatally

Question 4

What anticoagulants should not be used in pregnancy?

Answer 4

Warfarin - can cause foetal bleeding and teratogenicity

Question 5

When should LWMH be stopped?

Answer 5

12 hours before administration of an epidural. This is to reduce the risk of bleeding and because of drug interactions

Question 6

How is PE diagnosed in pregnancy?

Answer 6

CXR

Question 7

How is DVT diagnosed in pregnancy?

Answer 7

Bilateral leg dopplers

Question 8

When should prophlyactic LMWH be given?

Answer 8

Antenatal - only high risk groups

Postpartum - if two or more risk factors, prescribed for at least a week

Question 9

How long after vaginal delivery/c-section can LMWH be started?

Answer 9

24 hours