Critical Illness in Obstetric Patients: Venous Thromboembolism in Pregnancy
Sanjeev Daya Chunilal,
Wee Shian Chan.
During pregnancy, the risk of venous thromboembolism (VTE) increases 2-5 fold and pulmonary embolism (PE) remains a leading cause of maternal mortality in developed countries.
For pregnant women with suspected deep vein thrombosis (DVT) or PE, the use of serial compression leg ultrasound (CUS) should be considered to exclude DVT whereas a normal ventilation perfusion lung scan likely excludes PE. A computer tomographic pulmonary angiogram (CTPA) could assist in ruling out PE in women who present with an abnormal chest radiograph.
Low molecular weight heparins (LMWH) are the agents of choice for treatment and thromboprophylaxis of pregnant patients with VTE but appropriate dosing changes throughout pregnancy remain uncertain.
Women with previously unprovoked VTE and those in whom VTE are provoked by previous pregnancies or use of oral contraceptive are at highest risk of VTE recurrence during pregnancy, and should be offered antepartum and postpartum thromboprophylaxis. On the other hand, women with prior VTE related to a transient risk factor would benefit from postpartum thromboprophylaxis. More research is needed to identify the absolute risk of VTE during pregnancy associated with more prevalent risk factors such as maternal age, obesity, and mode of delivery.
Keywords: Deep vein thrombosis, pulmonary embolism, pregnancy, Low molecular weight heparin, thromboprophylaxis, thrombolysis, Obstetric Patients, maternal mortality, mode of delivery, Dimer Testing for DVT
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