VTE in pregnancy Flashcards
(16 cards)
What are the risk factors of VTE in pregnancy?
Smoking, Parity over 3, Over 35 years, BMI > 30, Multiple pregnancy, Family history, IVF pregnancy
When do you start prophylaxis for VTE in pregnancy?
28 weeks if there are three risk factors, First trimester if there are four or more of these risk factors
When is prophylaxis considered even in the absence of other risk factors?
Hospital admission, surgical procedures or previous VTE, Medical conditions such as cancer or arthritis, high risk thrombophilias, Ovarian hyperstimulation syndrome
When are risk assessments for VTE performed?
At booking and after birth, but if they are admitted to hospital, undergo a procedure or develop significant immobility then reassess
What do you give women at risk of VTEs?
Low molecular weight heparin unless contraindicated (e.g., enoxaparin, dalteparin, tinzaparin)
When is VTE prophylaxis begun?
ASAP in very high risk patients and over 28 weeks in those high risk, continued throughout the antenatal period and for 6 weeks postnatally
When is prophylaxis stopped?
Temporarily stopped when the woman goes into labour and can be started immediately after delivery (except in PPH, spinal anaesthesia and epidurals)
What is given if there is a contraindication to LMWH?
Intermittent pneumatic compression with equipment that inflates & deflates to massage the legs, Anti-embolic compression stockings
What are the presentations of DVT?
Calf or leg swelling, Dilated superficial veins, Calf tenderness, Oedema, Colour changes
What are the presentations of PE?
SOB, Haemoptysis, Pleuritic chest pain, Hypoxia & tachycardia, Raised respiratory rate, Low grade fever, Haemodynamic instability
What is the investigation for DVT?
Doppler USS
What are the investigations for PE?
Chest X Ray, ECG
What are the definitive diagnosis investigations for VTE?
CTPA (carries higher risk of breast cancer in mum), VQ scan (carries higher risk of childhood cancer in fetus)
Why do you not do Wells score in pregnant women?
Not valid as D dimer is raised anyway in pregnancy
What is the treatment for VTE?
Immediately begin LMWH before confirming diagnosis, and then when excluded you can stop treatment. When confirmed, continue the LMWH plus 6 weeks postnatally or 3 months in total (whichever is longer). You can switch to oral anticoagulation after delivery.
What are the management options for women with a massive PE and haemodynamic compromise?
Immediate management as it is life threatening: Unfractionated heparin, Thrombolysis, Surgical embolectomy
