Venous thromboembolism in pregnancy and puerperium

Definition

• Thromboembolic disorders are among the leading causes of maternal death.

Aetiopathogenesis

Aetiology and risk factors

• In pregnancy, increased venous capacitance and venous pressure in the legs promote stasis, and there is a degree of hypercoagulability.
• Most thromboembolic events, however, arise postpartum from vascular trauma at birth; the risk remains raised for about 6 weeks after birth, and caesarean section increases it further.
• General risk factors are thrombophilias and acquired conditions such as prolonged immobility; most pulmonary emboli originate from deep vein thrombosis of the legs.

Clinical features

Clinical features and complications

• Calf oedema, cramping and tenderness also occur physiologically in pregnancy and may mimic signs of thrombosis.
• Rarely, septic pelvic thrombophlebitis with infected thrombi in the ovarian or iliac veins or vena cava occurs postpartum; it presents with fever persisting for days without another cause.

Diagnosis

• D-dimer levels rise in pregnancy; only a negative result is helpful, as it excludes thrombosis.
• Deep vein thrombosis in pregnancy and postpartum is usually diagnosed by Doppler ultrasound.

Keep learning in the app

Further reading (selection)

1. MSD Manual Professional Edition: Thromboembolic Disorders in Pregnancy

Cross-references