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Thromboembolic disorders during pregnancy
- 1. Thromboemb olic disorders during pregnancyFatimah Ali Almohaimeed 341212406
- 2. REALIZE THAT PREGNANCY ITSELF IS A THROMBOGENIC EVENT. WHY? introduction VTE
- 3. encompasses DVT and PE 1st thromboembolic disease is five times greater in pregnancy than in the nonpregnant state. 5X more ! -VTEs account for 9% of all maternal deaths in the United States. -Approximately 80% of VTEs in pregnancy are DVT and 20% are PE. -Approximately half of all VTEs occur in the antepartum period and appear to be evenly divided among the three trimesters. -PE occurs more frequently postpartum. Cesarean delivery imparts a three to five times greater risk than a vaginal delivery. Incidence: Introduction
- 4. Causes and risk factors increasing risk of thrombosis in pregnancy.
- 5. RISK FACTORS 2nd Physiological and anatomical changes during pregnancy: -Increased clotting factors (I, VII, VIII, IX, X), fibrinogen, plasminogen activator inhibitor-1 (PAI-1) levels. -Decreased in levels of protein S and fibrinolytic activity. -increased venous stasis and compression of the inferior vena cava and pelvic veins by the enlarging uterus. -vascular injury associated with delivery -increased activation of platelets and resistance to activated protein C. Risk factors Maternal medical conditions including heart disease, SCD, lupus, obesity, diabetes, and hypertension increase risk Recent surgery, personal and family history of VTE, bed rest or prolonged immobilization, smoking, age older than 35 years, multiple gestations, preeclampsia, and postpartum infection. Thrombophilias may be inherited or acquired. - Inherited Thrombophilias 8X increase maternal thromboembolic event risk (over ½ OF TVE events)
- 6. RISK FACTORS 2nd Risk factors
- 8. Manifestations and clinical pictures of DVT and PE 3rd DVT Over 70% of DVTs in pregnancy develop in the iliofemoral veins, which are more likely to embolize, and the majority are on the left side. can cause unilateral lower extremity swelling, pain, and erythema. A palpable cord may be detected. Manifestations and clinical pic PE - remains the leading cause of maternal mortality in developed countries. - PE most commonly originates from DVT in the lower extremities, occurring in nearly 50% of patients with proximal DVT. - Symptoms typically associated with PE are all common in pregnancy, such as shortness of breath, chest pain, cough, tachypnea, and tachycardia.
- 9. Manifestations and clinical pictures of DVT and PE 3rd Manifestations and clinical pic
- 10. Summary
- 11. Summary 4th summary Which DVTs most commonly give rise to pulmonary embolisms? a. Distal DVTs b. Illiofemoral region DVTs Which point during pregnancy carries the greatest risk of developing a VTE? a. 1st trimester b. 3rd trimester c. Postnatal d. intrapartum
- 12. Summary 4th summary Which of the following is NOT a risk factor for VTE? a. Hyperemesis gravidarum b. Hospital admission c. Prolonged labor d. oligohydramnios
- 14. Thank you
Editor's Notes
- Venous thromboembolism frequency during the puerperium has decreased remarkably as early ambulation has become more widely practiced.
- The most important of these is a personal history of thrombosis. Indeed, 15 to 25 percent of all venous thromboembolism cases during pregnancy are recurrent events (American College of Obstetricians and Gynecologists, 2011). Thrombophilias Although these disorders are collectively present in about 15 percent of white European populations, they are responsible for approximately 50 percent of all thromboembolic events during pregnancy (Lockwood, 2002; Pierangeli, 2011). Antithrombin deficiency and homozygosity for factor V Leiden mutation are the most potent of the inherited thrombophilias. Double or compound heterozygotes (for both factor V Leiden and prothrombin G20219A) are also at greater risk of VTE Include persistent antiphospholipid antibody syndromes (APS) (lupus anticoagulants or anticardiolipin antibodies). APS is present in 15% to 17% of women with recurrent pregnancy loss.
- More in Lt side ?> hypothesizes that this results from compression of the left iliac vein by the right iliac and ovarian artery, both of which cross the vein only on the left side. Yet, the ureter is compressed more on the right side! Between 30 and 60 percent of women with a confirmed lower-extremity acute deep-vein thrombosis have an asymptomatic pulmonary embolism
- Pain with foot dorsiflexion (Homans' sign) <not specific Thromboembolic disorders can occur without symptoms, with only minimal symptoms, or with significant symptoms. Also, calf edema, cramping, and tenderness, which may occur normally during pregnancy, may simulate Homans sign.