Thromboembolic disorders: treatment and diagnosis

Thromboembolism is the highest cause of maternal mortality during childbirth (Figure 1 and Table 1). Midwives are in a prime position to identify women likely to be at higher than average risk and initiate medical referral. They can also assist with diagnosis of thromboembolic disorders and discuss preventive or curative care with affected women. Maternal mortality rates in the UK have declined from 10.3 per 100 000 (1988-90) to 9.8 per 100 000 maternities between 1991 and 1993 (Department of Health, 1996). Unfortunately, deaths from thrombosis and thromboembolism have remained relatively high over the past 20 years. Some maternal deaths, including those from cerebral thrombosis, occurred following sudden collapse or demise in previously asymptomatic women. However, in a significant number of cases reported in the latest enquiry (Department of Health, 1996), possible symptoms were misdiagnosed by professional carers. With extra mindfulness of who is at risk and by providing appropriate preventive treatment, it may be possible to achieve a reduction in deaths from this cause. This article reviews the risk factors which may be amenable to prophylactic treatment and the signs, symptoms and treatment of thromboembolism.