Thromboembolism

Thromboembolism remains a leading cause of obstetric morbidity and mortality in the United States. This chapter discusses the pathophysiology, diagnosis, treatment, prevention and special considerations of acute thromboembolism. The diagnosis of deep venous thrombosis (DVT) is often difficult to make clinically, especially in pregnancy. The presenting signs and symptoms of pulmonary embolism (PE) include shortness of breath, chest pain, tachypnea, tachycardia, and decreased oxygen saturation by pulse oxymeter. Acute DVT or PE should be treated with full anticoagulation using either intravenous heparin or subcutaneous low-molecular-weight heparin, and it is important to achieve therapeutic doses very early to prevent extension of clot. The use of anticoagulation to prevent thromboembolism is more controversial. Traditionally, chemoprophylaxis has been recommended to pregnant patients with a history of thrombosis with the idea that pregnancy significantly increases the risk of recurrence.