Venous Thromboembolism in Pregnancy
Pregnancy and the puerperium increase venous thromboembolism risk through hypercoagulability, venous stasis and vascular injury; suspected deep-vein thrombosis or pulmonary embolism needs prompt objective testing and therapeutic low-molecular-weight heparin unless strongly contraindicated.
Definition
Venous thromboembolism in pregnancy or the puerperium is thrombosis in the deep venous system or pulmonary embolism caused by embolisation to the pulmonary arteries. Pregnancy, birth and the postnatal period alter coagulation and venous flow, so suspected VTE requires a pregnancy-specific diagnostic and anticoagulation pathway.
First principles
Pregnancy creates a prothrombotic state
Pregnancy combines increased clotting factors and fibrinogen, reduced natural anticoagulant activity, venous dilatation and compression of pelvic veins by the gravid uterus. Delivery adds vascular and tissue injury. The risk is present throughout pregnancy and is particularly high in the puerperium, so risk assessment must be repeated rather than done once.
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