Practice Clinical Update

Diagnosis and management of deep vein thrombosis in pregnancy

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j2344 (Published 31 May 2017) Cite this as: BMJ 2017;357:j2344
  1. Faizan Khan, MSc epidemiology student1 2,
  2. Christian Vaillancourt, associate professor of emergency medicine, emergency physician1 2 3,
  3. Ghada Bourjeily, associate professor of medicine, pulmonary and critical care, obstetric medicine physician4
  1. 1Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8L6
  2. 2Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
  3. 3Department of Emergency Medicine, The Ottawa Hospital, Ottawa, ON, Canada
  4. 4Warren Alpert Medical School of Brown University, The Miriam Hospital, Providence, RI, USA
  1. Correspondence to: F Khan fkhan039{at}uottawa.ca

What you need to know

  • Diagnosis of deep vein thrombosis (DVT) in pregnant women can be difficult given that the Wells’score and D-dimer are not validated for use

  • Compression ultrasonography with Doppler examination of the iliofemoral region is the first line diagnostic tool

  • Anticoagulation with low molecular weight heparin is the preferred treatment for pregnant women with DVT, but optimal duration and dosing schedule remain unclear

  • Women with DVT related to pregnancy are at higher risk of embolic complications and of post-thrombotic syndrome than non-pregnant women

  • Management of DVT around labour and delivery involves balancing the risk of bleeding from anticoagulation with the risk of clot recurrence and the need for regional anaesthesia

Venous thromboembolism includes deep vein thrombosis (DVT) and pulmonary embolism. In DVT a blood clot forms in the lower extremities that may break off and travel to the lungs causing a pulmonary embolism. DVT is more common than pulmonary embolism during pregnancy1 and will constitute the focus of this clinical update. However, the prevalence, risk factors, and therapeutic options for DVT and venous thromboembolism in pregnancy are closely linked, and thus information regarding venous thromboembolism in pregnancy has also been covered where appropriate or when data regarding DVT are unavailable. Among pregnant women, pulmonary embolism is the most serious complication of DVT and remains one of the leading causes of maternal death in the developed world.2 Pregnancy related DVT is associated with a higher risk of embolic complications and of the post-thrombotic syndrome (chronic leg pain, intractable oedema, leg ulcers) than DVT in non-pregnant women.13 This article provides an update on the diagnosis and management of pregnant women with DVT.

How common is DVT in pregnancy?

The risk of venous thromboembolism in pregnancy is about four times the risk among non-pregnant women of childbearing age4; it is highest in the third trimester …

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