How to investigate and manage acute thrombosis in pregnancy

Abstract

Venous thromboembolism (VTE) remains the leading cause of direct maternal death in the UK, despite the widespread use of personalised risk-stratified thromboprophylaxis in pregnancy. The primary risk factors associated with VTE are increasingly common, namely obesity, medical comorbidities and maternal age. Therefore, it is imperative that all clinicians seeing pregnant patients acutely can adequately assess, investigate and treat possible VTE. Clinical diagnosis of VTE is challenging due to its non-specific symptoms that mirror obstetric physiology. This article will consider the management of deep vein thrombosis (DVT), pulmonary embolism (PE) and cerebral venous thrombosis (CVT). Universally, prompt imaging and anticoagulation are required. The support of obstetric, haematology, medical, radiology and anaesthetic specialists is imperative for the complex or critically ill patient. Thrombolysis should be considered with massive PE associated with haemodynamic instability and not withheld due to pregnancy. Critically, these patients require multidisciplinary plans for delivery, contraception and future pregnancy.