VTE in Pregnancy

Question 1

Which groups are categorised at high risk of VTE?

Answer 1

1. History of unprovoked VTE/>1 provoked VTE
2. High risk thrombophilia
3. Low risk thrombophilia with family history

Question 2

Which groups are categorised as intermediate risk of VTE?

Answer 2

1. Single provoked VTE
2. Cancer/inflammatory/SLE/sickle/nephrotic
3. IVDU
4. Any antenatal surgery

Question 3

What is the management for high risk VTE?

Answer 3

LMWH (enoxaparin) throughout pregnancy and 6 weeks postpartum.

Question 4

What VTE prophylaxis is needed in emergency lower segment C-section?

Answer 4

7 day postpartum LMWH

Question 5

What adjuncts are used in VTE prophylaxis in pregnancy?

Answer 5

Mobilisation, hydration, compression stockings.

Question 6

What is the protocol for VTE prophylaxis during labour?

Answer 6

1. LMWH stopped
2. Avoid epidural until 12 hours after last dose of prophylaxis or 24 hours after last dose of treatment.
3. LMWH started 12 hours after C-section.

Question 7

If a leg USS is -ve for DVT but the patient has symptoms what should be done?

Answer 7

VQ scan

Question 8

When should you start and stop treatment for suspected VTE and what medication is used?

Answer 8

1. Start as soon as suspected, stop once ruled out.

2. LMWH preferred, consider warfarin post-delivery.