How I manage venous thromboembolism in pregnancy

In pregnancy, the combination of altered coagulation factors, stasis and vascular damage heightens the thrombotic risk and venous thromboembolism (VTE) is a major cause of maternal morbidity and mortality. In women presenting with pregnancy-related VTE, the wellbeing of both mother and fetus must be considered, necessitating a multidisciplinary approach. The risk of VTE is present throughout the pregnancy and is maximal during the postpartum period. Diagnosis may be difficult because the symptoms might mimic those of pregnancy and prospectively validated diagnostic protocols are lacking. Compression ultrasound is the test of choice for deep vein thrombosis and perfusion scan and computerized tomography pulmonary angiography are the imaging options for diagnosis of pulmonary embolism. Low molecular weight heparin does not cross the placenta and is a safe and effective treatment for the majority of cases of pregnancy-related VTE. This review provides a practical approach to diagnosis and treatment of VTE in pregnancy.