VTE during pregnancy and puerperium

Question 1

Leading Direct cause of maternal death in uk

Answer 1

Pulmonary Embolism

2nd most common cause of maternal death overall - 11% of maternal deaths

Question 2

Many antenatal VTE events occur in which period of pregnancy

Answer 2

1st trimester

Question 3

Highest risk period of VTE is during

Answer 3

Postpartum

Question 4

Is CS a risk factor of VTE

Answer 4

CS is a significant risk factor of VTE, but women having vaginal delivery are also at risk.

Question 5

Relative risk of VTE in pregnancy and postpartum

Answer 5

In pregnancy it increases 4-6 times and increases 5 times further postpartum

Question 6

Incidence of VTE in pregnancy and puerperium

Answer 6

1-2/1000

Question 7

Risk factors of VTE in pregnancy

Answer 7

1. Age >35 y
2. BMI >25
3. CS
4. Antepartum immobilisation (>1 week rest)
5. Long travel >4h

Question 8

Is obesity a risk factor of VTE

Answer 8

• Obesity is a moderate risk factor of vte but it’s important due to its high prevalence.
• Obesity is a high risk of Pulmonary embolism more than DVT

Question 9

What is considerd a long travel?

Answer 9

a travel more than 4 hours

Question 10

What is antepartum immobilisation?

Answer 10

a strict bed rest 1 week or more before delivery

Question 11

Any woman with >4 risk factors other than thrombophilia and previous VTE is advised with

Answer 11

Prophylactic LMWH from antenatl period till 6 weeks postnatal

Question 12

Any woman with 3 risk factors other than thrombophilia and previous VTE is advised with

Answer 12

Prophylactic LMWH from 28 W gestational till 6 weeks postnatal

Question 13

Any woman with 2 risk factors other than thrombophilia and previous VTE is advised with

Answer 13

Prophylactic LMWH 10 days postpartum
Mobilization
Hydration

Question 14

If woman presented with hyperemesis gravidarum or Ovarian hyperstimulation syndrome

Answer 14

Prophylactic LMWH till resolution

Question 15

Woman with previous single VTE with Major surgery is advised to (excluding thrombophilia associated VTE)

Answer 15

Prophylactic LMWH through out antenatal period till 6 w postpartum

Question 16

Woman with previous recurrent VTE is advised to (excluding thrombophilia associated VTE)

Answer 16

Prophylactic high dose LMWH throughout antenatal period
till 6 w postpartum or returning to oral anticoagulant

Question 17

Woman with previous unprovoked VTE is advised to (excluding thrombophilia associated VTE)

Answer 17

Prophylactic LMWH through out antenatal period till 6 w postpartum

Question 18

Recurrence rate of VTE in subsequent pregnancies

Answer 18

1.4 - 11%

Question 19

Recurrence rate or unprovoked VTE

Answer 19

5.9%

Question 20

Single previous VTE is subdivided into:

Answer 20

1. Unprovoked VTE
2. Estrogen-provoked VTE (estrogen contraception)
3. Thrombophilia or family history associated VTE
4. Temporary risk factors associted VTE (trauma)