Deep Vein thrombosis

What an practicing Obstetrician should know on Thromboembolism??

Point 1:-DVT remains a leading cause of obstetric morbidity and mortality.

. Point 2:- It is the hypercoagulable nature of pregnancy is the prime cause: of DVT & PE . Point 3 The hypercoagulable nature of pregnancy It remains more common in the postpartum period than during pregnancy. It is now recognized that a significant portion of these thrombotic events occur as early as the first trimester, it is prudent to start treatment soon after the pregnancy is recognized and viability confirmed, and continue until 6 weeks post delivery.

 . Point 4 Why DVT is more common in Pregancy??  The increased prevalence is due to arterio of equilibrium or balance of procoagulant and anticoagulant factors in the circulation pendulm favoring  toward clot formation during pregnancy. Under normal circum­stances, the increased levels of clotting factors do not result in thrombus formation, but some clinical situations such as trauma or vascular injury may predispose toward lower extremity clotting. Point 5 :- Other risk factors for thrombosis during pregnancy include venous status, inactivity, obesity, prior thrombosis, antiphospholipid syndrome and thrombophilias such as factor V Leiden mutation.

It is estimated that the risk of venous thrombosis is approximately five times higher during pregnancy than in the non­pregnant state due to the hypercoagulable nature of pregnancy. While previously thought to be more prevalent in the third trimester, it is now recognized to occur at similar frequencies throughout pregnancy. Point: 6:-  Despite its risk, thromboembolism during pregnancy is a poorly studied area and significant controversy remains over the management of pregnant women at risk for this disorder. Pathophysiology-of thrombosis--Normal pregnancy is associated with an increase in the level or activity of many of the clotting factors in the blood. These increases provide a defense against hemorrhage after delivery, but they also contribute to thrombus formation. Once formed, portions of the clot can emblozie  to the pulmonary tree, with symptoms rang­ing from mild hypoxia to cardiovascular collapse. With mild to moderate symp & few signs