A clinical approach to the management of thrombosis in obstetrics. Part 2: diagnosis and treatment of venous thromboembolism

Abstract

Key content The diagnosis of venous thromboembolism requires objective testing, which can be done safely throughout pregnancy. Low molecular weight heparin is the most suitable agent for both prophylaxis and treatment of venous thromboembolism in pregnancy. Once labour has commenced, heparin should not be administered. It is recommended that anticoagulants be resumed 4–6 hours after vaginal delivery and 6–12 hours after caesarean delivery. Learning objectives To be able to choose the most appropriate diagnostic tests for venous thromboembolism in pregnancy. To be able to prescribe the most appropriate anticoagulants. To be able to manage women on anticoagulants appropriately during the different stages of pregnancy. Ethical issues The risks to the fetus of anticoagulant therapy are outweighed by the health benefits to the mother. Women of reproductive age on oral anticoagulants should know about warfarin embryopathy. Please cite this article as: Asghar F, Bowman P. A clinical approach to the management of thrombosis in obstetrics. Part 2: diagnosis and treatment of venous thromboembolism. The Obstetrician & Gynaecologist 2007;9:3–8.