Venous thromboembolism during pregnancy and postpartum period

• Published in: European journal of internal medicine Vol. 97; pp. 8 - 17
• Main Authors: Bukhari, Syed, Fatima, Shumail, Barakat, Amr F., Fogerty, Annemarie E., Weinberg, Ido, Elgendy, Islam Y.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.03.2022
• Subjects: Deep venous thrombosis; Female; Humans; Maternal mortality; Postpartum; Postpartum Period; Pregnancy; Pregnancy Complications, Cardiovascular - epidemiology; Pregnancy Complications, Cardiovascular - therapy; Pulmonary embolism; Risk Factors; Venous thromboembolism; Venous Thromboembolism - drug therapy; Venous Thromboembolism - epidemiology; Pregnancy; Pulmonary embolism; Maternal mortality; Deep venous thrombosis; Venous thromboembolism; Postpartum
• ISSN: 0953-6205; 1879-0828
• DOI: 10.1016/j.ejim.2021.12.013

•VTE is one of the leading etiologies of maternal morbidity and mortality, which is potentially preventable.•Rates of VTE during pregnancy and postpartum have not decreased over the past two decades.•CTPA is the preferred diagnostic modality for suspected PE, especially with modern low-dose techniques further reducing the radiation exposure.•Management of DVT is primarily with anticoagulation, while the management of PE depends on the risk stratification algorithm, ranging from anticoagulation to advanced therapies Venous thromboembolism (VTE) is one of the leading causes of maternal mortality. Rates of VTE during pregnancy and the postpartum period have not decreased over the past two decades and pregnancyassociated VTE continues to pose a significant health challenge. Pregnant and postpartum women are at a higher risk for VTE owing to many factors. There are hormonally mediated and pregnancy-specific alterations of coagulation that favor thrombosis, including increased production of clotting factors. There are physiologic and anatomic mechanisms that also contribute, including a decreased rate of venous blood flow from the lower extemities as pregnancy progresses. Cesarean delivery also introduces VTE risk. In addition, studies have demonstrated that pregnancy-associated complications such as pre-eclampsia or peri-partum infections are associated with increased VTE rates. In this review, we discuss the recent epidemiological studies, pathogenesis, risk factors and clinical presentation as well as therapeutic options for VTE during pregnancy and the postpartum period. We also provide proposed diagnostic algorithms for diagnosis and management of VTE during pregnancy and the postpartum period based on updated evidence. Finally, we highlight knowledge gaps to guide future research.