ACOG Guidelines Issued for Thromboembolism in Pregnancy

Guidelines cover diagnosis, treatment, and prevention of thromboembolism in pregnancy

FRIDAY, Aug. 26 (HealthDay News) -- Pregnant women are at an increased risk of venous thromboembolism, which can be prevented, diagnosed, and managed according to clinical guidelines published in the September issue of Obstetrics and Gynecology.

Andra James, M.D., from the Duke University School of Medicine in Durham, N.C., and the Committee on Practice Bulletins-Obstetrics from the American College of Obstetrics and Gynecology provided information on the risk factors, diagnosis, management, and prevention of thromboembolism, particularly venous thromboembolism during pregnancy.

The investigators reported that the risk of thromboembolism is higher during the first week postpartum than during pregnancy. Risk factors identified include history of thrombosis, acquired and inherited thrombophilias, physiologic changes accompanying pregnancy, medical factors, and pregnancy complications. Swelling and pain in extremities suggest new-onset venous thrombosis, and initial diagnostic test should be compression ultrasonography of the proximal veins. Management of venous thromboembolism requires therapeutic anticoagulation with unfractionated heparin or low molecular weight heparin (LMWH), which is compatible with breast-feeding, and can be resumed four to six or six to 12 hours after vaginal or cesarean delivery, respectively, to minimize postpartum bleeding. Women with a history of thrombosis, without previous evaluation of possible underlying etiologies, should be tested for both antiphospholipid antibodies and inherited thrombophilias. In the last month of pregnancy, or if delivery is imminent, LMWH should be replaced with shorter half-life unfractionated heparin. Pneumatic compression devices should be left in place until anticoagulant therapy is restarted postpartum and patient is ambulatory. Neuraxial blockade should be withheld up to 10 to 12 hours after last prophylactic dose or 24 hours after last therapeutic dose of LMWH.

"The prevalence and severity of this condition during pregnancy and the peripartum period warrant special consideration of management and therapy," the authors write.

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