Postgrad Med 2000 Sep 15;108(4):71-2, 77-8, 81-4
Thromboembolism during pregnancy. Risks, challenges, and recommendations.
Sellman JS, Holman RL.
Pregnancy is an important risk factor for venous thrombosis, and venous
thromboembolism is a leading cause of preventable death in pregnancy. Diagnosis
of venous thromboembolism is complicated in that the symptoms of dyspnea and
lower extremity edema are relatively common complaints of pregnant patients.
Physicians should maintain an appropriately high index of suspicion and request
diagnostic imaging in a timely manner. Diagnosis of deep venous thrombosis with
Doppler ultrasonography of the lower extremity poses no health risk to the
fetus, but other radiographic studies pose a low radiation risk to the fetus.
Because anticoagulant therapy poses a greater health risk to mother and fetus
than does the radiation required for the diagnosis of pulmonary embolism,
clinicians should aggressively pursue objective evidence of venous
thromboembolism. Once the diagnosis is made, anticoagulation with intravenous
unfractionated heparin or subcutaneous low-molecular-weight heparin should be
used prepartum followed by warfarin therapy after delivery.