Flashcards in DVT, pulmonary embolus & amniotic fluid embolism Deck (12)
What is Deep vein thrombosis?
DVT occurs when a blood clot (thrombus) dorms in one of the deep veins (usually in the legs)
What is the role of the midwife with regard to deep vein thrombosis?
- collaborative care
- screening for risk
- physical examination
- education (risks, symptoms, antiembolitic stockings)
- encourage ambulation intrapartum and postpartum
- administration of prophylactic anticoagulants
- avoid dehydration
- planning timing of thromboprophylaxis around birth
What are the key risk factors for DVT?
- previous Hx of thrombosis
- family Hx
- maternal age>35
- varicose veins
- cardiac or lung disease
- multiple pregnancy
- intrauterine growth restriction
- CS or instrumental
- prolonged labour> 24h
- APH or PPH
- preterm birth
What are the signs/symptoms of DVT?
- unilateral redness, swelling or pain in leg
- low grade fever
- prominent superficial veins
- decreased pulse
- difficulty bearing weight
Why are pregnant women at increased risk of clotting?
- increased venous stasis
- decreased venous outflow
- compression of inferior vena cava and pelvic veins by uterus
What is pulmonary embolus?
a blockage (usually a clot) of the pulmonary artery that takes blood to the lungs
- often a DVT that has travelled
What are the signs and symptoms of a pulmonary embolus?
- shortness of breath
- chest pain
- coughing blood
- sudden hypotension
What is an amniotic fluid embolism?
- rare obstetric emergency
- amniotic fluid enters maternal circulation and causes massive anaphylactic reaction (not IgE mediated) or activates complement cascade
- usually during labour or other procedure
- pathophysiology is poorly understood
What are the two phases of amniotic fluid embolism?
1. pulmonary artery vasospasm, pulmonary hypertension, hypoxia, damage to myocardium and pulmonary capillaries, leading to heart failure and acute respiratory distress
2. massive haemorrhage, uterine atony, DIC
What are the risk factors for amniotic fluid embolism?
- advance maternal age
- placenta praevia
- placental abruption
- operative birth
- induction of labour
What are the signs/symptoms of amniotic fluid embolism?
- sudden and severe deterioration
- fetal distress
- pulmonary oedema
- cardiopulmonary arrest
- diagnosis is often postmortem