Thromboembolic disease in pregnancy

Thromboembolic disease is a major cause of maternal morbidity and mortality during pregnancy and the puerperium. Anticoagulation during pregnancy remains an area of controversy and uncertainty. VTE is considered to be a multifactorial disorder in which acquired and genetic risk factors interact dynamically [8]. The risk of maternal VTE with underlying thrombophilia depends on the underlying thrombophilic defect, history of thrombotic events, and additional risk factors. Inherited thrombophilias have been associated with pregnancy complications that include recurrent and repeated unexplained fetal loss, placental infarction, second trimester pregnancy loss, and increased rates of stillbirth. Patients who have known thrombophilia should be counseled that they are at increased risk of thrombosis associated in thrombogenic situations, including surgery, pregnancy, or immobilization. Therapeutic anticoagulation treatment should be given, regardless of antecedent thromboembolic history, to women who have the most potent thrombophilias, including those who are homozygous for factor V Leiden mutation or the Prothrombin 20210A = Prothrombin mutation or those who have two coexisting thrombophilias, AT-III deficiency, or antiphospholipid antibody syndrome. Counseling should include discussions that women who have thrombophilia are more prone to coronary artery disease, stroke, and peripheral vascular disease. These women should have monitoring of blood pressure, lipid levels, and glucose and should be warned that the detrimental effects of smoking are increased. Although the optimal treatment of thromboembolic disease is unknown, the practicing obstetrician must maintain a high level of clinical suspicion of the serious, and, often fatal, condition. Moreover, the clinician must be aware of current treatment guidelines to prevent and treat thromboembolic complications. Prophylaxis is recommended for those who are at increased risk. Therapeutic anticoagulation is recommended for those who are at highest risk. LMWH is the treatment of choice for most situations because of its lower associated risk of serious complications.