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

Recurrence rate of VTE in subsequent pregnancies

Answer 15

1.4 - 11%

Question 16

Recurrence rate or unprovoked VTE

Answer 16

6%

Question 17

at term, the diameter of the ovarian vein is increased by…….-fold compared with the non-pregnant state.

Answer 17

Three

Question 18

What is the VTE risk score for a pregnant patient at booking with the following factors: age 36, IVF pregnancy with twins, and type 2 diabetes?

Answer 18

3

Question 19

What is the VTE risk score for a patient with a history of venous thromboembolism (VTE) during a previous pregnancy?

Answer 19

4

Question 20

5. Which thrombophilias are considered low risk in pregnancy?

Answer 20

heterozygous FVL - Prothrombin G

Question 21

When should prophylactic and therapeutic doses of low molecular weight heparin (LMWH) be stopped before cesarean section (CS) by regional analgesia?

Answer 21

prohylactic: 12 hrs
theraputic: 24 hrs

Question 22

How can VTE be prevented in a pregnant patient with a history of recurrent VTE?

Answer 22

may require higher dose of LMWH

Question 23

How can VTE be prevented in a pregnant patient with a history of recurrent VTE and antiphospholipid syndrome (APS)?

Answer 23

Lifetime anticoagulant= high dose LMWH (50%,75% or 100% dose) antenatally+ 6 w postnatally or until return to oral anticoagulant

Question 24

Which inherited thrombophilia carries the highest risk of thrombosis?

Answer 24

Antithrombin 3