*Thromboembolic Disease

Question 1

What is deep vein thrombosis (DVT)?

Answer 1

Blood clot in one or more of the deep veins

Question 2

What is a pulmonary embolism (PE)?

Answer 2

A blood clot that travels to your lungs blocking major blood vessels

Common cause of maternal mortality (direct cause of almost a quarter of maternal deaths in 2009-2018)

Question 3

What are the 3 factors of Virchow’s triad?

Answer 3

1. Stasis of flow i.e. abnormalities of blood flow
2. Vascular damage/vessel wall injury i.e. damage to endothelial layer
3. Coagluation changes / Hypercoagulability i.e. abnormalities of blood thickness

Question 4

What are the risk factors for developing DVT?

35 POIP HP PET

Answer 4

• > 35yo
• Increased parity
• Obesity
• Prolonged immobility
• Pelvic trauma
• Surgery during pregnancy (including CS)
• Hereditary thrombophillia
• Previous/family history of VTE
• Pre-eclampsia

Question 5

What are the signs and symptoms of a DVT?

Answer 5

• Pain
• Redness / heat
• Swelling

Potentially also throbbing, cramping

Question 6

How should a DVT be managed?

Answer 6

• Start LMWH (anti-coagulation)
• Stop when labour starts or 24h before planned birth
• TEDS / IPC (intermittent pneumatic compression)

Question 7

What are the signs and symptoms of a PE?

Answer 7

• Shortness of breath
• Chest pain (sharp on deep in-breaths)
• Cough (may have blood streaking)

May also experience
* rapid or irregular HR
* Lightheadedness or dizziness
* Excessive sweating
* Fever
* Leg pain or swelling, or both, usually in the calf
* Cyanosis (bluish/purple hue to skin)

Question 8

What does Virchow’s triad represent?

Answer 8

Three contributing factors that result in thrombosis / blood clot

Question 9

What puts pregnant / postpartum women at increased risk of VTE in terms of stasis?

Answer 9

• Compression of iliac veins
• Gravid uterus (obstruction of venous flow)
• Hormones causing vein dilation
• Immobilisation

Question 10

What puts women at increased risk of VTE in terms of vascular damage?

Answer 10

• Vasular compression at birth
• Assisted or operative delivery

Question 11

What puts women at increased risk of VTE in terms of hypercoagulable blood?

Answer 11

• More thrombin production
• Less clot dissolution

Question 12

Why are TEDS / anti-embolism stockings used post CS?

Answer 12

To reduce the risk of DVT formation

Statis of blood flow - CS leads to reduced mobility which can slow down blood flow in the legs, increasing the risk of blood clot formation. Compression stockings counteract this by providing external pressure on the legs which aids in VENOUS RETURN and REDUCES STASIS. Femoral vein velocity increased.

Vessel wall damage - There is potential for endothelial injury during a CS. Compression stockings can help support the integrity of the endothelium by promoting proper blood flow and reducing the risk of venous distension and further damage.

Question 13

Why is IPC / Intermittent Pnematic Compression used post CS?

Answer 13

To reduce the risk of DVT formation.

Stasis - increases femoral vein velocity

Coagulation changes - manipulation of muscle mass stimulates fibrinolysis

Question 14

Ongoing care for women wearing TEDS and/or using IPC?

Answer 14

Observe and document

Colour, Warmth, Movement, Sensation - on application, then as per policy

Skin integrity - remove at least 1x per day or more if high risk of skin integirty

Stocking care - wash every 2-3 days, do not use ointments, machine/hand wash, dry out of sun, should last 2-3 months

Question 15

In a postnatal check, when checking legs, what are we concerned about?

Answer 15

Pain
Redness
Heat
Swelling