Q. What are obstetrical risk factors of venous thromboembolism in pregnant women?
Investigations of DVT in pregnancy
- Treatment with LMWH should be started once the clinical suspicion has been raised (unless there is a strong contraindication),
- Clinical decision rules such as Wells score are not validated for use in pregnancy.
| Investigation | Finding |
| D-dimer |
|
| Doppler USG of affected limb |
|
| MRI of the abdomen |
|
| USG abdomen with Pregnancy profile |
|
| ECG, CXR, troponin, |
|
| V/Q scan (if CXR normal)
CTPA (if CXR abnormal) |
|
| CBC, CRP |
|
| RF, ANA, APS panel |
|
| RFT, LFT, urinalysis, glucose |
|
Treatment:
- Maintain hydration, mobility
- Inj LMWH: higher dose than outside of pregnancy
- For massive PE: systemic or catheter directed thrombolysis
| Before pregnancy | During pregnancy | During labor | During breastfeeding |
|
|
Careful planning around the time of delivery to balance the need for anticoagulation against bleeding risk from anesthetic procedure and delivery. |
*** DOAC: unsafe |