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Systemic Thromboembolism in Pregnancy: Venous Thromboembolism

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Disorders of Thrombosis and Hemostasis in Pregnancy

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Abstract

Pregnancy is a prothrombotic state, associated with a 5- to 10-fold increased risk of venous thromboembolism (VTE) compared with the non-pregnant state. VTE (which includes deep vein thrombosis, pulmonary embolus and cerebral vein thrombosis) remains a leading cause of maternal morbidity and mortality, despite improvements in prevention in recent years. Clinical diagnosis of VTE in pregnancy is difficult, and clinicians should have a low threshold for investigating women with suspected VTE in pregnancy. Low molecular weight heparin (LMWH) is the mainstay in the treatment of VTE. The primary aim in peripartum management is to balance the risk of major postpartum hemorrhage in a woman who is fully anticoagulated with the risk of extension or recurrence of VTE when anticoagulation is interrupted.

In general, being on treatment doses of anticoagulation is often an indication for timing delivery, but would not be an indication for elective Caesarean section; induction of labour is usually preferable. Once the immediate peripartum period has been negotiated, consideration is given to the duration of further therapeutic anticoagulation. Therapeutic anticoagulation should be continued for the duration of the pregnancy, and for at least 6 weeks postnatally and until at least 3 months of treatment has been given in total.

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Author information

Authors and Affiliations

  1. St Georges Healthcare NHS Trust, SW17 0QT, London, UK

    Asma Khalil MD, MRCOG, MSc.

  2. Department of Hematology, Barts Health NHS Trust, 4th floor, Pathology and Pharmacy, Building, 80 Newark Street, Whitechapel, E1 2ES, London, UK

    Louise Bowles MRCP, FRCPath

  3. Department of Obstetrics and Gynaecology, University College London Hospitals, London, UK

    Pat O’Brien FRCOG, FFSRH, FICOG

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  1. Asma Khalil MD, MRCOG, MSc.
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  2. Louise Bowles MRCP, FRCPath
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  3. Pat O’Brien FRCOG, FFSRH, FICOG
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Correspondence to Asma Khalil MD, MRCOG, MSc. .

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Editors and Affiliations

  1. Aberdare Gardens 36, London, NW6 3QA, United Kingdom

    Hannah Cohen

  2. Dept. Obstetrics & Gynaecology, University College Hospital, Chenies Mews 86-96, London, WC1E 6HX, United Kingdom

    Patrick O'Brien

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Khalil, A., Bowles, L., O’Brien, P. (2012). Systemic Thromboembolism in Pregnancy: Venous Thromboembolism. In: Cohen, H., O'Brien, P. (eds) Disorders of Thrombosis and Hemostasis in Pregnancy. Springer, London. https://doi.org/10.1007/978-1-4471-4411-3_4

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