Venous thromboembolism in pregnancy.
In Western nations, venous thromboembolism (VTE) is an important cause of morbidity and the most common cause of maternal death during pregnancy and the puerperium. Pregnancy is a hypercoagulable state in which coagulation is activated and thrombolysis inhibited. This prothrombotic risk is compounded when hereditary and acquired thrombophilias and other prothrombotic risk factors are present. The risk of venous thrombotic events is increased fivefold during pregnancy and 60-fold in the first 3 months after delivery (postpartum period) compared with nonpregnant women. Many of the signs and symptoms of VTE overlap those of a normal pregnancy, which complicates the diagnosis. Patients with history of previous VTE should use graduated compression stockings throughout pregnancy and the puerperium, and should receive postpartum anticoagulant prophylaxis. The indications for antepartum anticoagulant prophylaxis are somewhat controversial. This article reviews the management of VTE during pregnancy and in the postpartum period.
Division of Pulmonary and Critical Care Medicine, EVMS Internal Medicine, Eastern Virginia Medical School, HH Suite 410, 825 Fairfax Avenue, Norfolk VA 23507, USA. marikpe@evms.edu
Paul E
PE
Marik
D000925:Anticoagulants / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D011655:Pulmonary Embolism / Q000628:therapy; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight