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7 - Diagnosis of deep vein thrombosis and pulmonary embolism in pregnancy

Published online by Cambridge University Press:  01 February 2010

By
William F. Baker Jr., M.D., F.A.C.P., ,
Eugene P. Frenkel M.D., F.A.C.P.,  and
Rodger L. Bick M.D., Ph.D., F.A.C.P.
Edited by
Rodger L. Bick ,
Eugene P. Frenkel ,
William F. Baker  and
Ravi Sarode
William F. Baker Jr., M.D., F.A.C.P.,
Affiliation:
Associate Clinical Professor of Medicine Center for Health Sciences, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, CA, USA Thrombosis, Hemostasis, and Special Hematology Clinic, Kern Medical Center, Bakersfield
Eugene P. Frenkel M.D., F.A.C.P.,
Affiliation:
Professor of Medicine and Radiology Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical School, Dallas, Texas, USA
Rodger L. Bick M.D., Ph.D., F.A.C.P.
Affiliation:
Clinical Professor of Medicine and Pathology, University of Texas Southwestern Medical Medical Center, Director: Dallas Thrombosis Hemostasis and Vascular Medicine Clinical Center, Dallas, Texas, USA
Rodger L. Bick
Affiliation:
University of Texas Southwestern Medical Center, Dallas
Eugene P. Frenkel
Affiliation:
University of Texas Southwestern Medical Center, Dallas
William F. Baker
Affiliation:
University of California, Los Angeles
Ravi Sarode
Affiliation:
University of Texas Southwestern Medical Center, Dallas
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Summary

Venous thromboembolism (VTE) represents a major cause of morbidity and mortality during pregnancy, complicating from 0.5 to 3.0 of every 1000 pregnancies. Pulmonary embolism (PE) has been the leading cause of maternal mortality in the United States and Great Britain for at least 20 years and complicates approximately 1 in 1,000 pregnancies. This represents a VTE risk of 3–4 times greater than age-matched non-pregnant controls. Diagnosing venous thromboembolism is challenging because clinical findings are often misleading. When evaluated with objective testing, as many as 75% of patients suspected of having venous thromboembolism are found to have an alternative diagnosis. This poses an even greater problem in the pregnant patient who experiences vasodilatation and intravascular volume expansion (20–25% increase) with associated lower extremity edema. The accuracy of many diagnostic tests used in the non-pregnant patient are either not useful at all or are potentially misleading. Diagnosis of VTE is critical since 24% of pregnant women with untreated deep vein thrombosis (DVT) develop PE, with a death rate of 15% to 30%. Proper diagnosis and treatment reduces the mortality rate of PE to 1%–3%. In addition, postphlebitic syndrome in the affected leg occurs nearly 80% of the time following DVT in pregnancy, compared to 30–40% in the non-pregnant patient. Although it is well recognized that the incidence of PE is greatly reduced with treatment for deep vein thrombosis (DVT), treatment is also problematic since anticoagulation regimens used in the non-pregnant patient may be highly teratogenic or in other ways hazardous to mother and/or fetus.

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Information
Hematological Complications in Obstetrics, Pregnancy, and Gynecology , pp. 222 - 249
Publisher: Cambridge University Press
Print publication year: 2006

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  • Diagnosis of deep vein thrombosis and pulmonary embolism in pregnancy
    • By William F. Baker, Jr., M.D., F.A.C.P.,, Associate Clinical Professor of Medicine Center for Health Sciences, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, CA, USA Thrombosis, Hemostasis, and Special Hematology Clinic, Kern Medical Center, Bakersfield, Eugene P. Frenkel, M.D., F.A.C.P.,, Professor of Medicine and Radiology Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical School, Dallas, Texas, USA, Rodger L. Bick, M.D., Ph.D., F.A.C.P., Clinical Professor of Medicine and Pathology, University of Texas Southwestern Medical Medical Center, Director: Dallas Thrombosis Hemostasis and Vascular Medicine Clinical Center, Dallas, Texas, USA
  • Edited by Rodger L. Bick, University of Texas Southwestern Medical Center, Dallas, Eugene P. Frenkel, University of Texas Southwestern Medical Center, Dallas, William F. Baker, University of California, Los Angeles, Ravi Sarode, University of Texas Southwestern Medical Center, Dallas
  • Book: Hematological Complications in Obstetrics, Pregnancy, and Gynecology
  • Online publication: 01 February 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511526978.008
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  • Diagnosis of deep vein thrombosis and pulmonary embolism in pregnancy
    • By William F. Baker, Jr., M.D., F.A.C.P.,, Associate Clinical Professor of Medicine Center for Health Sciences, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, CA, USA Thrombosis, Hemostasis, and Special Hematology Clinic, Kern Medical Center, Bakersfield, Eugene P. Frenkel, M.D., F.A.C.P.,, Professor of Medicine and Radiology Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical School, Dallas, Texas, USA, Rodger L. Bick, M.D., Ph.D., F.A.C.P., Clinical Professor of Medicine and Pathology, University of Texas Southwestern Medical Medical Center, Director: Dallas Thrombosis Hemostasis and Vascular Medicine Clinical Center, Dallas, Texas, USA
  • Edited by Rodger L. Bick, University of Texas Southwestern Medical Center, Dallas, Eugene P. Frenkel, University of Texas Southwestern Medical Center, Dallas, William F. Baker, University of California, Los Angeles, Ravi Sarode, University of Texas Southwestern Medical Center, Dallas
  • Book: Hematological Complications in Obstetrics, Pregnancy, and Gynecology
  • Online publication: 01 February 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511526978.008
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  • Diagnosis of deep vein thrombosis and pulmonary embolism in pregnancy
    • By William F. Baker, Jr., M.D., F.A.C.P.,, Associate Clinical Professor of Medicine Center for Health Sciences, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, CA, USA Thrombosis, Hemostasis, and Special Hematology Clinic, Kern Medical Center, Bakersfield, Eugene P. Frenkel, M.D., F.A.C.P.,, Professor of Medicine and Radiology Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical School, Dallas, Texas, USA, Rodger L. Bick, M.D., Ph.D., F.A.C.P., Clinical Professor of Medicine and Pathology, University of Texas Southwestern Medical Medical Center, Director: Dallas Thrombosis Hemostasis and Vascular Medicine Clinical Center, Dallas, Texas, USA
  • Edited by Rodger L. Bick, University of Texas Southwestern Medical Center, Dallas, Eugene P. Frenkel, University of Texas Southwestern Medical Center, Dallas, William F. Baker, University of California, Los Angeles, Ravi Sarode, University of Texas Southwestern Medical Center, Dallas
  • Book: Hematological Complications in Obstetrics, Pregnancy, and Gynecology
  • Online publication: 01 February 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511526978.008
Available formats
×