Thromboembolism in pregnancy

Question 1

What is Thromboembolism in pregnancy and how to Ix

Answer 1

Pregnancy increase coagulation-

can get DVT and PE a lot easier

DVT-> duplex USS
PE- CTPA > V/Q scan- NO D-dimer
ABG, ECG
CXR, 
baseline bloods- before antigoagulation

Question 2

Immediatement Mx of DVT in pregnancy

Answer 2

LMWH + elevated leg, apply stickings
compression USS if suspicion of DVT- if neg can stop
if neg and high clinical suspicion- repeat USS day 3 and 7

Question 3

Immediate Treatment of PE in pregnancy

Answer 3

Minor PE- LMWH
ECG/CXR- if suspicious of PE- CTPA
USS if DVT as well
VQ scan has some risks for baby
CTPA risk for mum cancer

Massive PE- IV unfractionated heparin
2nd line- thrombolytic therapy, surgical embolectomy

Question 4

Mx of Central venous sinus thrombosis in pregnancy

Answer 4

Most common saggital sinus-
Headache/ neuro signs
Ix-MRI
Mx- IV unfracitonated hepatin, thrombolysis-> 3-6m anticoag

Question 5

Maintenance and prevention VTE in pregnancy

Answer 5

Maintenant- SC LMWH for at least 6w post natal
breastfeeding fine
SE-thombocytopenia

Prevention-
at 12w booking based on risk -
Prolonged LMWH use, elastic stickings
from 12w-> 10 days PP if 4risk factors, 
from 28w until 10w pp- 3 risk factors
consvervative- 3 RF

Question 6

VTE at delivery

Answer 6

if VTE at term- IV unfractionaed heparin
If on LMWH maintenance mx- do not give more
if planned- stop VTE 24h before

anesthetcis- epidural no at least until 24h after lase dose
LMWH not given until at least 4h post removal of epidural catherter