VENOUS

THROMBOEMBOLISM

intro
VTE includes
DVT
PE

PE common cause direct maternal

death and it is rising trend

Why in pregnancy
Hypercoagulatable state
Physiology
Venous statis
Increased factor viii, ix,x, fibrinogen
Px increase risk 6 folds (first trimes till
6w postpartum
C section increase 10-20 folds

 Thrombophilia
History of-antiphospholipid synd,
antithrombin deficiency

 Increase risk factors

Obesity
Comorbidities
Older age at pregnancy

 Thromboembolism remains a
significant
But preventable cause of maternal
death

VTE RISK MANAGEMENT

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Risk scoring
Risk scoring for antenatal and
postnatal women for vte is probably
the most effective way of identifying
those at risk and requiring
prophylaxis treatment

Risk score chart

The strategies
Creating awareness
prevention
Health clinic-identify very high risk pt
manage/refer
Hosp discharge- communicating with
health pt high risk or on treatment

Early detection
Awareness risk fact, sign and symptoms

Identify high risk patients

Health staff-able to identify very high
risk for vte
Nurses doing home visit-assess post
natal for vte
Assessment
Antenatal
postnatal

Who needs prophylaxis

Patients who should be given prophy
Ant score >3
Post score >2

Low risk score <2

Encourage ambulate
Avoidance dehydration
Seek tx early feeling unwell
Seek treatment develop s&s dvt/pe
Compression stocking

Risk vte post natal higher (lower score need

prophy)

Which thromboprophylaxis
LMWH is preferred-once daily and
safe self administered
Enoxaparine/clexane &
tinzaparin/innohep-efficacious and
safe-porcine
Heparin bd dose-given by medical
staff
fondaparinux

Which pt will go to health clinic for

injection
Not keen self injection
heparin

DVT
Important to note that half of all dvt
asymp
S&sm
Swelling one or both legs
Pain/tenderness while standing or
walking
Warmth in the skin affected leg
Leg fatigue

Especially when occur SUDDENLY

PE
Pe vary greatly depending how much
lung involved, size clot and comobid
S&sm
SOB sudden -active or rest
Chest pain-worse on exertion but not go
away when rest
Cough- bloody or blood streaked sputum
Wheezing

 Clammy or bluish skin

Excessive sweating
Rapid or irregular heartbeat
Weak pulse

Home visit-vte risk

assessment

General wellbeing
S&sm DVT
S&sm PE
60% PE during postnatal

leaflet
Vte information leaflet
Heparin
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Terima kasih