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Deep Vein Thrombosis and Pulmonary Embolus in Pregnancy

Reviewed 06/2018
 


BASICS

DESCRIPTION

Blood clots formed in the deep veins of the lower extremities (deep vein thrombosis [DVT]) or pelvis (iliac vein thrombosis) are at risk of traveling to the lung, causing a pulmonary...

DIAGNOSIS

HISTORY

  • Often asymptomatic

  • DVT: leg pain, tenderness, swelling (most common in left leg [70–90%] due to right iliac artery overlying left iliac vein)

  • PE: dyspnea, pleuritic pain, cough, syncope

PHYSICAL EXAM

TREATMENT

GENERAL MEASURES

  • Anticoagulation indicated for confirmed acute VTE (DVT, PE) for minimum 3 months and/or for 6 weeks postpartum

  • LMWH and unfractionated heparin (UFH) do not cross the placenta.

  • ...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Postpartum anticoagulation for acute VTE:

    • LMWH or UFH: Resume 4 to 6 hours after vaginal delivery, 6 to 12 hours after cesarean (1)[B], 12 hours after removal of e...

REFERENCES

1
Linnemann B, Bauersachs R, Rott H, et al; for Working Group in Women's Health of the Society of Thrombosis and Haemostasis. Diagnosis of pregnancy-associated venous thromboembolism—positio...

ADDITIONAL READING

  • Bates SM, Greer IA, Middeldorp S, et al. VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of ...

CODES

ICD10

  • O22.30 Deep phlebothrombosis in pregnancy, unspecified trimester

  • O88.219 Thromboembolism in pregnancy, unspecified trimester

ICD9

  • 671.30 Deep phlebothrombosis, antepartum, unspecified as to ep...

CLINICAL PEARLS

  • Highest risk of VTE is in the postpartum period.

  • Add color-coded Doppler US to the traditionally used CCUS in pregnant patients to better evaluate the iliac veins; alternatively may use...

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