Venous thromoboembolic disease and pregnancy

Abstract

Although venous thromboembolism is a preventable and treatable condition, it remains the most common cause of direct maternal death in the UK, with a four-fold increased incidence compared to that of the non-pregnant population. The risk of VTE is apparent from early pregnancy and maximal immediately postpartum. Increasing rates of obesity and maternal age over 35 years are in part responsible for this escalation and are likely to continue to rise exponentially over the next decade. Targeted prophylaxis in those considered at increased risk should be offered antenatally with regular reassessment of individual risk throughout pregnancy. Many of the symptoms attributable to VTE are common in normal pregnancy; therefore a high index of suspicion and a low threshold for objective investigation are important. Unfounded fears concerning the potential adverse effects of ionising radiation on fetal wellbeing often serve to delay investigation and treatment. This article provides an overview of the pathophysiology, diagnosis, treatment and prevention of VTE in pregnancy and refers the reader to recent evidence based guidelines.