7.7. Complications of Pregnancy - Venous Thrombo-Embolism

Question 1

Why is there a risk of Venous Thrombo-Embolism in Pregnancy?

Answer 1

Pregnancy is a Hypercoaguable State

Question 2

Why is Pregnancy a Hypercoaguable State?

Answer 2

To protect the Mother against Bleeding in Post-Delivery

Question 3

What changes occur in Pregnancy to cause the Hypercoaguable State?

Answer 3

1. Increase in Fibrinogen / Factor VIII / Von Williebrand Factor / Platelets
2. Decrease in natural Anticoagulants - Antithrombin III
3. Increase in Fibrinolysis

Question 4

Who is at Risk of developing Venous Thrombo-Embolism?

Answer 4

1. Older Mothers / Increasing Parity
2. Increase BMI
3. Smokers / I.V. Drug Users / Infection
4. Pre-Eclampsia / Haemorrhage / Previous Venous Thrombo-Embolism
5. Dehydration
6. Decreased Mobility
7. Operative Delivery / Prolonged Labour

Question 5

What is the Prophylactic Treatment of Venous Thrombo-Embolism?

Answer 5

1. TED Stockings
2. Advice Increasing Mobility
3. Prophylactic Anticoagulation - with 3+ Risk Factors

Question 6

What are the Signs / Symptoms of Venous Thrombo-Embolism?

Answer 6

1. Pain in Calf / Increased Girth of Affected Leg
2. Dyspnoea / Pain on Breathing / Cough / Pleural Rub
3. Tachycardia / Hypoxia

Question 7

What investigations occur for a Pregnant Woman with suspected Venous Thrombo-Embolism?

Answer 7

1. ECG
2. Blood Gasses
3. Doppler
4. Ventilation / Perfustion (V/Q) Lung Scan
5. CT Pulmonary Angiogram (CTPA)

Question 8

What is the treatment of Venous Thrombo-Embolism in a Pregnant Woman?

Answer 8

Appropriate Anticoagulation