Venous thromboembolism in the pregnant woman

Abstract

The incidence of venous thromboembolism (vein thrombosis [DVT] and pulmonary embolism [PE]) increases sharply in pregnant women. The 3 primary contributing factors in VTE--hypercoagulability, stasis and endothelial injury--can all occur in association with pregnancy. Symptoms that may suggest VTE are often inherent in pregnancy, such as leg pain and shortness of breath, making clinical diagnosis problematic. The use of objective diagnostic testing for VTE is complicated in pregnancy because many of the tests commonly used present a potential risk to the fetus. Heparin does not cross the placenta and is not teratogenic, making it the first-line treatment for VTE. Low-molecular-weight heparins are typically the drug of choice for prophylaxis and treatment of VTE in pregnant women.