Diagnosis and management of thrombosis in pregnancy

Pregnancy-related thrombosis is a major cause of maternal mortality. Pregnancy and the puerperium are associated with a fourfold to fivefold increased risk of thrombosis when compared with the nonpregnant state. The greatest time of risk is in the postpartum period. Diagnosis of venous thromboembolism (VTE) during pregnancy can be challenging as many of the symptoms can be associated with normal pregnancy. Almost all deep venous thrombosis occurs in the left leg or iliac veins. Diagnostic procedures for pulmonary embolism carry some exposure to radiation, although risks are low when compared with risks associated with an undiagnosed maternal PE. The anticoagulant of choice during pregnancy is low-molecular-weight heparin. Certain medical conditions require alternative approaches as management around the time of delivery. In women with VTE during pregnancy, anticoagulation should continue for at least 3 months and until at least 6 weeks postpartum.