Pulmonary Thromboembolism and Embolism in Pregnancy

Complications

Obie Editorial Team

Venous thromboembolism is a serious disorder that is the result of blood clots that form on the walls of veins. For pregnant women, VT is the number one risk of death during delivery of the baby. Often, venous thromboembolism has a hereditary aspect but can originate from a number of genetic and lifestyle factors. It is crucial that a diagnosis of this disorder occurs as soon as possible and it is highly recommended that all pregnant women undergo tests to see if they have or are at risk of developing this disorder in order to protect the life of both mother and child.

Causes
Venous thromboembolism is caused by a number of predetermining and developed factors. Obesity, smoking, dehydration, trauma, and older age are just a few of the many causes of this disorder, which can be greatly exacerbated by pregnancy. Hospitalization has been shown to greatly increase the chance of developing venous thromboembolism as it is currently the number three on the list of causes of hospital death and the number one common cause of preventable hospital death. In most cases, a combination of multiple factors contributes to the development of venous thromboembolism and any one instance does not cause it on its own.

Diagnosis

Diagnosis of venous thromboembolism can be difficult in general but in circumstances of pregnancy, often it will develop in the lower left leg and can be observed through a localized swelling of the affected area. Observational assessments can often be misleading, as many symptoms of venous thromboembolism can develop during pregnancy as a result of other conditions, leading many physicians unable to definitively pinpoint VT as the cause. Clinical assessments have been developed to rank individuals into three categories based on the likelihood of developing the disorder, which allow physicians to move forward with a variety of steps and treatments to combat the issue.

Treatment
Since venous thromboembolism is a manifestation of blood clotting, the general course of action for treating this problem is anti-coagulation, or blood thinners. Medications and procedures used include unfractioned and LMW heparin, warfarin, direct thrombin inhibitors, vena caval interruption and pulmonary embolectomy. The duration of treatment is evaluated against the likelihood of recurrence. The most common form of treatment during pregnancy is the use of anti-coagulants. This is the easiest way to treat the disorder but can cause complications for both the mother and the baby in certain circumstances.

Prognosis
Venous thromboembolism is third on the list of common cardiovascular diseases and with that notoriety, short-term and long-term complications for some individuals can be expected. The recurrence rate of the disease following successful treatment is approximately 30% after ten years and for some patients, indefinite treatment must continue. There is a four-fold increase in risk of VT during pregnancy and a five-fold increase in that risk for several weeks following the delivery of the baby. Individuals who are 35 years of age or older, have had a cesarean section or have spent an abnormal amount of time in the hospital are at increased risk of developing VT or suffering from complications as a result of it.