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Pregnancy

Pregnancy increases a women’s risk for DVT 2-5 fold over a non-pregnant women of childbearing age. This risk is even greater in the post-partum (after delivery) period. 85% of all pregnancy related symptomatic events are related to DVT, with 2/3 occurring antepartum (before delivery), half before the third trimester, with most DVT’s occurring in the left leg. Pulmonary embolism (PE) is the most common cause of maternal death in developed countries. If additional risk factors are added, the risk of DVT and PE is even greater than a woman where pregnancy alone is her only risk factor.

Talk to your doctor about your risks and ways to prevent VTE during pregnancy and after delivery.

Pregnancy causes changes in the body that increase risk
  • Alterations in blood that favor clotting
  • Reduced fibrinolysis- body is less likely to dissolve clots that have formed
  • Pooling of blood in the lower limbs
  • Damage to the endothelium (vein walls)

Additional risk factors
  • Age >35yrs old
  • Twin pregnancy
  • Bedrest
  • In-vitro fertilization
  • Cesarean Section
  • Post partum Hemorrhage
  • Infection
  • Pre-eclampsia
  • Past history of Venous Thromboembolism (VTE)
  • Thrombophilia (increased tendency to clot)
  • Chronic hypertension
  • Obesity
  • Smoking
  • Family history of VTE
  • Diabetes
  • Sickle Cell Disease

Treatment Options
  • Neither Low Molecular Weight Heparins (LMWH) or Unfractionated Heparin (UFH) cross the placenta therefore there should be no increased of harm to the baby or hemorrhage.
  • Warfarin or Coumadin dose cross the placenta and may cause harm to the baby. If used, the risks of not taking the drug should outweigh the risks to the mother and baby.
  • All of these medications will be held during the birth, but are usually restarted 12-24hours post delivery and continue for up to 6 months.
  • IVC filter placement is indicated in conditions where recurrent VTE occurs despite adequate anticoagulation, or if anticoagulation is contraindicated because of an increased chance of bleeding or a threat of pre-term labor. Insertion can be done safely using an abdominal shield minimizing radiation exposure to the fetus.
Recommendations
Postpartum prophylaxis is recommended for women with prior VTE, family history of VTE, and thrombophilia.

IVC filters placed during pregnancy should be removed within the first month after insertion.

References
IVC Filter Clinic | Northwestern Medicine