Management of the Obstetric Patient with Thromboembolic Disease

SUMMARY

Physiological changes in clotting factors and venous flow during pregnancy increase the likelihood of deep venous thrombosis. Conditions that place the pregnant patient at a higher risk include a previous history of thromboembolic disease, and surgery or bed-rest for any reason during the pregnancy. In the high-risk patient, prophylactic therapy with low-dose heparin is advised beginning around the 34th week of pregnancy and continuing until 4–6 weeks after delivery. The clinical diagnosis of thrombophlebitis or pulmonary embolus is unreliable and should be confirmed objectively before therapy is started. The preferred method of therapy is full anticoagulation followed by subcutaneous heparin for the remainder of the pregnancy and the puerperium, although there is considerable controversy regarding long-term therapy. Fibrinolytic agents have no place in pregnancy and surgical therapy should be reserved for the severely ill patient.