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Deep Vein Thrombosis and Pulmonary Embolus in Pregnancy

Prabhcharan Gill, MD Reviewed 06/2021
 


BASICS

Deep vein thrombosis (DVT) can be isolated, typically in the lower extremity or the iliac veins. Thromboses may break away and present as venous thromboembolism (VTE). 

DESCRIPTION

Both pregnancy...

DIAGNOSIS

HISTORY

  • Often asymptomatic, but 80% present with a swollen painful lower extremity (3)

  • DVT: leg pain, tenderness, swelling (most common in left leg [70–90%])

  • PE: dyspnea, pleuritic pain, cough...

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

Risk of osteoporosis secondary to Heparinoids is recognized and can be addressed by oral calcium supplements. 

FOLLOW-UP RECOMMENDATIONS

  • Postpartum anticoagulation for acute VTE:

    • LMWH or UFH...

REFERENCES

1
Chang J, Elam-Evans LD, Berg CJ, et al. Pregnancy related mortality surveillance--United States 1991-1999. MMWR Surveill Summ. 2003;52(2):1.
2
Linnemann  B, Bauersachs...

ADDITIONAL READING

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

CODES

ICD10

  • O22.30 Deep phlebothrombosis in pregnancy, unspecified trimester

  • O88.219 Thromboembolism in pregnancy, unspecified trimester

SNOMED

  • 682004 Thrombosis complicating pregnancy AND/OR puerperium (...

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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