Deep Vein Thrombosis in Pregnancy

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Deep vein thrombosis (DVT) and acute pulmonary embolism (PE) are two manifestations of venous  thromboembolism (VTE. The risk of VTE is increased in pregnancy by about five timesbecause of a  more hyper-coagulable state. VTE contributes to significant maternal morbidity and mortality. The  mainstay of therapy for DVT is anticoagulation, provided there is no contraindication 

Clinical presentation 

  • Pain on the affected limb
  • Swelling or redness of the calf or thigh
  • Homan’s sign (pain in the calf in response to dorsiflexion of the foot)

Investigations 

  • Venous doppler ultrasound
  • Venography (CT MRI)
  • Fibrin degradation product (FDP) or D-dimer

Prevention of DVT 

  • Early passive and active ambulation in women undergoing major obstetric surgery
  • Compressive stockings in women ≥100kg undergoing obstetric surgery
  • LMWH prophylaxis 5000IU within 1-hour post-surgery to at risk women.

Pharmacological Treatment 

B:  unfractionated  heparin  (SC)  5,000  bolus  and  subsequent  15,000–20,000  doses  at 12hourly intervals (under supervision of a specialist) 

OR   

S: low molecular weight heparin (SC) 1mg/kg 12hourly 

OR 

C:  warfarin  (PO)  5mg  24hourly  (in  delivered  women)  consider  bridging  warfarin  with Heparin  for  5days  as  it  takes  longer  to  act.  Warfarin  to  be  continued  up  to  6weeks  postpartum 

Note: Check PTT every 4hours and PTT should be maintained at 1.5–2.5 X control. Once steady state has  been achieved measure PTT levels daily. Change heparin to SC route after 5–10days 

Referral:  Immediate referral to a hospital with expertise and monitoring of the treatment through  laboratory testing is recommended.