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Chapter-19 Thromboembolism in Pregnancy

BOOK TITLE: Management of High-Risk Pregnancy—A Practical Approach

Author
1. Batra Swaraj
2. Malhotra Sarita
ISBN
9789380704739
DOI
10.5005/jp/books/11228_19
Edition
1/e
Publishing Year
2010
Pages
16
Author Affiliations
1. Maulana Azad Medical College and Lok Nayak Jai Prakash Hospital, New Delhi, India, MAMC and Lok Nayak Hospital, New Delhi, Maulana Azad Medical College and LN Hospital, New Delhi, MAMC and LNH, New Delhi, Maulana Azad Medical College and Associated Lok Nayak Jay Prakash Hospital, New Delhi, Maulana Azad Medical College, New Delhi, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, Maulana Azad Medical College and Loknayak Hospital, New Delhi, India, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India, Delhi
2. Maulana Azad Medical College and Lok Nayak Jai Prakash Hospital, New Delhi, India
Chapter keywords

Abstract

Venous tromboembolism is the leading cause of maternal mortality in western world. These women may also suffer from poor pregnancy outcomes which include recurrent pregnancy losses, intrauterine growth restriction, stillbirths, early onset, severe preeclampsia and abruption placentae. Pregnant and postpartum women are at increased risk of VTE. The various indications for screening a pregnant woman for of thrombophilias include personal history of venous thromboembolism, family history of venous thromboembolism, history of unexplained stillbirth, severe unexplained IUGR, early onset severe preeclampsia, recurrent abortions and first degree relative with a specific mutation. Majority of patients are asymptomatic and hence a high index of suspicion helps in early diagnosis and timely treatment. Real-time ultrasonography with color Doppler is the investigation of choice for diagnosis of DVT. CT and MRI are alternative modalities to establish the diagnosis of DVT and are indicated when there is a strong clinical suspicion of DVT and ultrasound findings are equivocal or negative. Women with thrombophilic disorders should be counseled about increased risk of thrombosis and adverse outcomes during pregnancy and offered prophylactic antepartum and postpartum anticoagulant therapy. Timely institution of therapeutic and prophylactic anticoagulation can prevent maternal morbidity and mortality. LMWHs are preferred anticoagulants unless there are cost constraints. If the patient was on warfarin she should be switched to heparin after 36 weeks. It should be stopped as soon as patient perceives labor pains. For elective delivery, LMWH should be stopped 24 hours before induction of labor or cesarean section. Anticoagulation is restarted 8 to 12 hours after vaginal delivery and 18 to 24 hours after cesarean section.

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