Venous thromboembolism is a major cause of maternal mortality during pregnancy, and low-molecular-weight heparin remains the preferred anticoagulant therapy for its management.
Provides a clinical overview of the diagnosis, screening, and management of venous thromboembolism during pregnancy, highlighting low-molecular-weight heparin as the preferred treatment.
Venous thromboembolism is the leading cause of maternal death in the United States. Pregnancy is a risk factor for deep venous thrombosis, and risk is further increased with a personal or family history of thrombosis or thrombophilia. Screening for thrombophilia is not recommended for the general population; however, testing for inherited or acquired thrombophilic conditions is recommended when personal or family history suggests increased risk. Factor V Leiden and prothrombin G20210A mutation are the most common inherited thrombophilias, and antiphospholipid antibody syndrome is the most important acquired defect. Clinical symptoms of deep venous thrombosis may be subtle and difficult to distinguish from gestational edema. Venous compression (Doppler) ultrasonography is the diagnostic test of choice. Pulmonary embolism typically presents postpartum with dyspnea and tachypnea. Multidetector-row (spiral) computed tomography is the test of choice for pulmonary embolism. Warfarin is contraindicated during pregnancy, but is safe to use postpartum and is compatible with breastfeeding. Low-molecular-weight heparin has largely replaced unfractionated heparin for prophylaxis and treatment in pregnancy.
Dresang et al. (Tue,) conducted a review in Venous Thromboembolism in Pregnancy. Low-molecular-weight heparin (LMWH) was evaluated. Venous thromboembolism is a major cause of maternal mortality during pregnancy, and low-molecular-weight heparin remains the preferred anticoagulant therapy for its management.
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