gynecology and obstetrics
Thromboembolic Disorders in Pregnancy
Key Points
During pregnancy, risk of thromboembolic disorders is increased, but most thromboemboli develop postpartum and result from vascular trauma during delivery. Symptoms of thrombophlebitis or their absence does not accurately predict the diagnosis, disease severity, or risk of embolization. Diagnose deep vein thrombosis using Doppler ultrasonography, but postpartum, if Doppler ultrasonography and plethysmography findings are normal but pelvic venous thrombosis is suspected, do CT with contrast. Diagnose pulmonary embolism using helical CT or, if needed, pulmonary angiography. Low molecular weightheparin(LMWH) is the treatment of choice;warfarinshould be avoided during pregnancy. Treat high-risk women prophylactically with LMWH as soon as pregnancy is diagnosed and continue until 6 weeks postpartum. 