Oral Presentation Society of Obstetric Medicine of Australia and New Zealand ASM 2015

Venous thromboembolism in pregnancy (#1)

Beverley Hunt 1
  1. Guy's & St Thomas' NHS Foundation Trust, London, ., United Kingdom

Antenatal and postnatal venous thromboembolism (VTE) is around 10 and 25 times more common respectively, than in non-pregnant women of the same age and is a major cause of direct maternal mortality in the developed world. European studies have consistently found the pregnancy-related VTE mortality to be 8.5–14 per million live births.  A recent study showed that the increased risk of VTE extended to 12 weeks post partum.  In the United Kingdom, sequential reports from Confidential Enquiries into Maternal Deaths have demonstrated that VTE remains the main direct cause of maternal death and have highlighted failures in obtaining objective diagnoses and employing adequate treatment. The rate of maternal mortality due to VTE peaked between 1996-6 at 2.18 deaths per 100,000 maternities. It gradually fell to 0.79 for the period of 2006-8 but there has been a reversal of the trend between 2009-11 with a rate of 1.26 deaths per 100,000 maternities.Many consider that with the epidemic of obesity and the rising age of UK mothers this has not been counterset by the increased use of thromboprophylaxis.The subjective, clinical assessment of DVT and PE is particularly unreliable in pregnancy and a minority of women with clinically suspected VTE have the diagnosis confirmed when objective testing is employed.  It is essential that objective testing is performed in women with suspected VTE. Failure to identify VTE will place the mother’s life at risk, whilst unnecessary treatment is associated with risks, inconvenience and costs during the pregnancy and may also have implications for her future health care (including future use of oral contraception and hormone replacement therapy, and thromboprophylaxis in future pregnancies). However this policy has led to CTPA being performed liberally in many pregnant women with chest symptoms and several papers have shown that the actual number of positive scans reported are between 1-2% of all scans performed exposing 49 women to potentially unnecessary radiation to gain one positive diagnosis. This, new diagnostic techniques, a prospective trial to find diagnostic markers of pulmonary embolism in pregnancy (DiaPEP) and current management will be discussed.

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