The hypercoaguable state induced in pregnancy leads to many challenges in clinical management, including an increased risk of venous thromboembolism (VTE). There were 18 deaths in pregnancy attributable to VTE in 2006–2008, reflecting a fall which is attributable to the implementation of national guidelines.
A retrospective study was performed assessing whether guidelines were met regarding the initial management of suspected VTE in pregnancy. This included assessment of whether objective testing was performed expeditiously, and whether treatment with low-molecular-weight heparin (LMWH) until the diagnosis was excluded was commenced.
During the study period March 2012 to March 2013, 99 pregnant women (average BMI 29) underwent 96 compression duplex ultrasounds (the first line investigation as per RCOG guidelines). Of these, only 1 woman had a positive result. Where women initially had a negative duplex ultrasound result, 8 women went on to have a PE diagnosed at V/Q scan.
In the remaining 3 women, all underwent ventilation-perfusion (V/Q) scans as their first line investigation, and none had a positive result. 2 women went on to have a CTPA after multidisciplinary discussion. Both of these were unwell with shortness of breath and chest pain, however neither had a PE and both were diagnosed with pneumonia.
10 women did not receive therapeutic LMWH whilst waiting for objective testing. 5 antenatal women and 2 postnatal women received the incorrect therapeutic dose of LMWH whilst waiting for investigations. 13 women were considered high risk and were already taking LMWH at the time of presentation.