Thromboembolism in Pregnancy: Gynecologists Perspective

Abstract

AbstractPregnancy is a thrombogenic condition in both antenatal and postpartum periods. Venous thromboembolism (VTE) is a common cause of morbidity, and the cause of maternal death in such situations is pulmonary embolism. There are several risk factors for thrombotic phenomena in pregnancy both acquired and hereditary. Accurate diagnosis of deep vein thrombosis (DVT) and its treatment are very important to prevent life-threatening pulmonary embolism. Among the diagnostic techniques, compression ultrasound is the mainstay for DVT diagnosis, whereas computed tomographic pulmonary angiography (CTPA) is for pulmonary embolism. Anticoagulants play a major role in therapy. They are used both in the active stage of thromboembolism and also in thromboprophylaxis in the postpartum period. Different types of heparins are available, which can be tailored to the individual requirements. During therapy they need monitoring to prevent hemorrhagic complications. Oral anticoagulants cannot be given in pregnancy as a general rule because of their teratogenicity, though they can be used in the postpartum period. Thrombolysis is can be taken up in selected cases in the acute situations. A very prolonged treatment of anticoagulants and compression stockings are needed in patients with past history of VTE. The most convenient drug regimen for prophylaxis is once-daily weight-adjusted low-molecular-weight heparin (LMWH). The goal of this article is to facilitate the recognition of thromboembolic disorders in pregnancy and different regimens in their management during antenatal, intrapartum, and postpartum periods. A few interesting and rare cases from the author’s experience are also presented at the end.