ICU · Obstetric critical care

Venous Thromboembolism in Pregnancy

Also known as VTE in pregnancy · DVT in pregnancy · PE in pregnancy · Pregnancy hypercoagulable · LMWH in pregnancy · Massive PE pregnancy · Perimortem Caesarean

Venous thromboembolism is a leading cause of maternal mortality because pregnancy activates all of Virchow triad — stasis (the gravid uterus compresses the IVC, progesterone venodilation, immobility), hypercoagulability (fibrinogen and factors VII, VIII, X and von Willebrand rise, protein S activity falls, fibrinolysis is impaired), and endothelial injury (delivery) — giving at least a 5-fold higher risk than in non-pregnant women with an even greater surge postpartum (a 4- to 10-fold increase across gestation and the puerperium). DVT is commonly left-sided (May-Thurner compression). Diagnosis uses compression ultrasound for DVT and V/Q (preferred) or CTPA for PE — never relying on D-dimer (it rises physiologically as pregnancy progresses) and never withholding imaging for fetal-radiation fears. Treatment is therapeutic LMWH (does not cross the placenta) dosed by current weight with rising requirements across trimesters; warfarin and DOACs are contraindicated antenatally; thrombolysis (alteplase most used) for massive PE; perimortem Caesarean (resuscitative hysterotomy) in arrest.