What is thromboembolism in pregnancy?
Venous thromboembolism in pregnancy is a clinical emergency that has been associated with significant risk for maternal and fetal morbidity and mortality. The adaptation of the maternal hemostatic system to pregnancy predisposes women to an increased risk of thromboembolism.
How does pregnancy increase risk of thromboembolism?
The main reason for the increased risk of VTE in pregnancy is hypercoagulability. The hypercoagulability of pregnancy, which has likely evolved to protect women from the bleeding challenges of miscarriage and childbirth, is present as early as the first trimester and so is the increased risk of VTE.
What should be done to prevent thromboembolism during postpartum period?
The options are to (1) stop LMWH when labor begins, with the possibility that a patient may not be able to receive epidural analgesia; (2) stop LMWH early (ie, at 37 weeks gestation) with exposure to a small risk of VTE during this time; or (3) plan to induce labor and stop the LMWH 12 to 24 hours after the last dose.
What causes thromboembolism in pregnancy?
During pregnancy, factors that increase the risk of developing DVT include varicose veins, diabetes multiple gestations, and more. The most common type of venous thromboembolism (VTE) is deep vein thrombosis (DVT), which refers to blood clots in the deep veins of the leg, arm, or pelvis.
Why is pregnancy hypercoagulable state?
Causes. Pregnancy-induced hypercoagulability is probably a physiologically adaptive mechanism to prevent post partum hemorrhage. Pregnancy changes the plasma levels of many clotting factors, such as fibrinogen, which can rise up to three times its normal value. Thrombin levels increase.
What do you mean by thromboembolism?
Thromboembolism is a medical term used to describe a blood clot (thrombus) that forms in a blood vessel, breaks loose, and is carried by the bloodstream to block another blood vessel. When an unattached mass of any sort (called an embolus) causes an obstruction, the blockage is referred to as an embolism.
When do you become hypercoagulable during pregnancy?
Markers of thrombin generation such as prothrombin F1 + 2 and thrombin-antithrombin (TAT) complexes are also increased. These changes, which may not completely return to baseline until more than 8 weeks postpartum, begin with conception and result in the hypercoagulable state of pregnancy.
Which thromboembolic medication is safe during pregnancy?
LMWHs are recommended for the treatment of acute DVT and PE in pregnancy because of equivalent or superior effectiveness and safety compared with unfractionated heparin. LMWHs are the agents of choice for antenatal thromboprophylaxis.
What is venous thromboembolism prophylaxis?
Venous thromboembolism (VTE) prophylaxis consists of pharmacologic and nonpharmacologic measures to diminish the risk of deep vein thrombosis (DVT) and pulmonary embolism (PE).
Which factors predispose a woman to thromboembolism?
The most important risk factors were high age, thrombophilia, cesarean section, obesity, chorioamnionitis, cardiac disease, varicose veins, and in vitro fertilization with ovarian hyperstimulation syndrome.
When do you become hypercoagulable in pregnancy?
Which coagulation factors increase during pregnancy?
During pregnancy, the concentrations of coagulation factors V, VII, VIII, IX, X, XII and von Willebrand factor rise significantly, accompanied by a pronounced increase in fibrinogen levels which increases up to two-fold from non-pregnant levels.