Why the study?
Venous thromboembolism remains a leading cause of maternal mortality and morbidity, and clinical diagnosis in pregnancy is difficult with historically limited benefit from scoring systems.
This review outlines the optimal approach to diagnosing and managing antenatal venous thromboembolism, highlighting the use of LMWH and multidisciplinary decision-making around delivery.
Supports LMWH-based antenatal VTE care; leaves open prospective validation of risk stratification.
Key content Venous thromboembolism (VTE) remains one of the leading causes of maternal mortality and morbidity in the developed world. Clinical diagnosis of antenatal VTE is difficult and scoring systems have historically been of limited benefit in the pregnant population. However, evidence is emerging to suggest that pregnant women can be risk stratified for pulmonary embolism without the need for imaging in all cases. Optimal treatment is with weight adjusted therapeutic dose low‐molecular‐weight heparin (LMWH) subcutaneously. In rare cases, there may be a role for retrievable inferior vena cava (IVC) filters. The obstetrician has a key role in the multidisciplinary team discussion with the aim of minimising maternal risk of haemorrhage or thrombosis. Learning Objectives To understand the optimal approach to diagnosing VTE in pregnancy and the antenatal management of acute VTE. To understand the rare indications, risks and benefits of IVC filters in pregnancy. To understand the complexity of decision making around the time of delivery to minimise the risk of bleeding and recurrent thrombosis.
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Crosby et al. (2021) studied this question.
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