Venous thromboembolism prophylaxis in pregnancy: Are we adequately identifying and managing risks?

Abstract

Pregnancy is a well‐known risk factor of venous thromboembolism. We retrospectively reviewed case histories of 82 pregnant women who developed symptoms of venous pathology, thrombophlebitis, deep vein thrombosis (DVT) or pulmonary embolus (PE) while receiving care at our hospital. We found the VTE risk identification and documentation during their pregnancies were deficient resulting in the omission of appropriate thromboprophylaxis. Many confirmed VTE cases (antenatally or postpartum) were not on thromboprophylaxis prior to diagnosis despite having multiple risk factors. We recommend the use of a risk assessment tool by clinicians for accurate risk identification ensuring proper risk management at different stages of pregnancy.

Evaluating Thromboprophylaxis Strategies for High-Risk Pregnancy: A Current Perspective

“…Varicose veins are a frequent finding in women with two or more pregnancies. Enhanced engorgement and impaired blood flow through them during pregnancy predispose the patient to thrombophlebitis [ 42 ]. Gross varicose veins were identified as a significant and often underestimated risk factor of VTE, with aOR of 2.69 (95% CI 1.53–4.7) [ 20 , 32 , 34 , 43 , 44 ].…”

“…However, it lacked validation studies of obstetric complications, and there was a scarcity of data estimating their prevalence in the global population. Moreover, data from other mentioned studies were retrospective [ 42 ] or obtained in a survey format [ 34 ].…”

The end of an era for ‘The Red Journal’

“…In obstetrics, much of that research concerns either antenatal screening (in the current issue, for example, we find non-invasive prenatal testing for genetic conditions, screening for antenatal depressive symptoms and diabetic retinopathy screening) [9][10][11] or prophylaxis (in this issue, for thromboembolism and post-operative infection following caesarean section). 12,13 In gynaecology, new techniques replace old -in this issue, outpatient hysteroscopy where once inpatient dilatation and curettage was used, 14 and day-case total laparoscopic hysterectomy, unimaginable in 1960, giving good results where once open hysterectomy with prolonged inpatient post-operative convalescence was standard. 15 However, pelvic pain remains enigmatic, as in 1961.…”