VTE in pregnancy ****

Question 1

Why does pregnancy increase the risk of VTE?

Answer 1

Pregnancy is a hypercoagulable state due to hormones

Question 2

Presentation of:

DVT - 3

PE - 3

Answer 2

Leg pain/swelling
Fever
Dizziness

SOB
Pleuritis chest pain
Haemoptysis

Question 3

Risk factors:

Obstetric - think of thing which would cause HTN, dehydration or immobility on top of the hypercoagulable state of pregnancy leading to clots

Over what parity is the risk increased?

Answer 3

HG
PET
C-section or other surgery during pregnancy (stasis of blood)
Labour >24 hrs 
PPH 

Multiparous - para>4

Question 4

Risk factors:

PMH:

• Typical PMH
• Thrombophilia increases risk. What is it?
• What conditions are pro-thrombotic? - 3
• Types of CVD?

Answer 4

FH or PMH of VTE
Thrombophilia - an imbalance in naturally occurring blood-clotting proteins, or clotting factors. This can put you at risk of developing blood clots.

Cancer
SLE
Nephrotic syndrome

Heart disease
Varicose veins

Question 5

Risk factors:

Lifestyle and demographic?

Answer 5

BMI - obesity
Age >35 - older women
Smoking
IVDU

Question 6

Investigations:

When is a risk assessment for VTE done? - 2

Diagnosis of VTE:

• How is a DVT diagnosed?
• How is a PE diagnosed? - 2
• Why can’t D-dimers be used?

ABCDE:

• Other blood tests that should be done before anticoagulation? - 3
• What imaging can be done for baseline? - 2

Answer 6

Booking appointment - antenatal prophylaxis
Delivery - postnatal prophylaxis

Compression US of the leg with doppler

V/Q scan - fetal cancer risk 
CTPA - maternal breast cancer risk 
---
FBC 
U&E
LFTs

CXR
ECG

Question 7

Management - Prophylaxis:

Antenatal:

• Indications - list some
• When should it be started?
• When should they be stopped?
• What if they have been started due to HG?

Answer 7

Previous VTE
Hospital admission during pregnancy
High-risk thrombophilia
Pro-thrombotic co-morbidity (cancer, SLE)

ASAP

At labour or 24 hr before elective delivery

Stop at discharge

Question 8

Management - Prophylaxis:

Postnatal:

• What is used as prophylaxis?
• How long after delivery do they continue prophylaxis?
• Prophylaxis may be prescribed for just 10 days after delivery. In what circumstance is this done in?

Answer 8

LMWH

6 wks

C-section
High BMI
Prolonged admission or readmission

Question 9

Management - Prophylaxis:

Non-pharmacological prevention:

• 2 ways mechanical compression is done?
• What should pregnant women avoid doing to prevent clots?

Answer 9

Compression stockings
Intermittent pneumatic compression devices

Dehydration
Prolonged immobilisation during pregnancy and the postpartum period

Question 10

Management - Treatment:

DVT and stable PE:

• Conservative Rx
• Drug used

Massive PE:

• What can be used which is also used in stroke?
• Drug used?

Answer 10

Elevate leg and compression stockings 
LMWH
--
Thrombolysis 
UF heparin alone 

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