VTE in pregnancy Flashcards
When are VTEs most common?
postnatal period
What are RFs for VTE?
⎫ Age > 35 ⎫ Body mass index > 30 ⎫ Parity > 3 ⎫ Smoker ⎫ Gross varicose veins ⎫ Current pre-eclampsia ⎫ Immobility ⎫ Family history of unprovoked VTE ⎫ Low risk thrombophilia ⎫ Multiple pregnancy ⎫ IVF pregnancy
Give the criteria for giving VTE prophylaxis in pregnancy
4 or more RF warrants immediate LMWH until 6 weeks postnatal
3 RF requires LMWH from 28 weeks
what are signs of DVT
→ Leg swelling (L>R) → Pain → Redness → Tenderness → Pyrexia → Lower abdo pain → WCC
What are signs of PE
→ SOB
→ Chest pain
→ Haemoptysis
− Pleural rub or fine creps on auscultation, usually no signs tho
What are signs of massive PE
hypoxia, BP, tachycardia, collapse leading to cardiac arrest
What is typical presentation of PE
− Collapsed pregnant or postpartum woman, feels faint, JVP, sx and signs of DVT
What are ix in VTE
i. FBC, U&E, LFTs, clotting screen
ii. ABG
iii. ECG
iv. CXR
What imaging is involved in DVT suspicion
compression or duplex US of deep veins
What imaging is involved if CXR and duplex US normal in PE
ventilation/perfusion lung scanning
When should treatment of suspected VTE begin?
as soon as there is suspicion
What is the rx of suspected VTE?
LMWH 28w to 6 w postnatal
What should b done is a diagnosis of dVT is made shortly before delivery?
continue anticoagulation for at least 3m
What should be done at delivery w regards to rx??
consider switching to warfarin post delivery as this is safe in breastfeeding
stop LMWH during labour
How should a pregnant woman be managed in subsequent pregnancies if they have VTE?
thromboprophylaxis throughout and 6 weeks postpartum
