Deep venous thrombosis and pulmonary embolism in pregnancy

Early diagnosis, treatment, and appropriate prophylaxis may prevent serious maternal sequelae of thromboembolism. Objective techniques for diagnosis should be used aggressively, using noninvasive methods such as Doppler or IPG when possible for DVT. 125I-fibrinogen should be avoided. The possible consequences of failure to treat or unnecessary use of anticoagulant therapy outweigh risks to the fetus of the appropriate radiologic procedures. Because of its low fetal risk, heparin is the anticoagulant of choice. Measurement of heparin levels by antifactor Xa activity appears to be more sensitive than the current standard, the aPTT, and it is hoped that this will become widely available. Although the risks and benefits of prophylaxis during pregnancy are currently debated, it appears most prudent to use subcutaneous heparin prophylaxis in doses larger than for nonpregnant patients in women at high risk for recurrence.