Management of thromboembolic disease associated with pregnancy

Our objective was to identify practice patterns of members of the Society of Perinatal Obstetricians with regard to the management of thromboembolic disease in pregnant women. We sent survey-questionnaires to members of the Society of Perinatal Obstetricians and requested information on antepartum and postpartum management of four clinical case scenarios. We also requested information on the evaluation of hypercoagulability and on the dosing and monitoring of heparin during pregnancy. We received 515 responses after a single mailing (47%). Most respondents utilize some form of anticoagulation in pregnant women with a history of thromboembolic disease, although there was variation in the duration and intensity of anticoagulation. Nearly all respondents (96%) use full anticoagulation with heparin for pregnant women with prosthetic heart valves. Most respondents evaluate pregnant women for hypercoagulable disorders who present with a thromboembolism or have a history of thromboembolic disease. There is considerable variation with respect to the dosing and monitoring of heparin therapy during pregnancy. Although most SPO members recommend anticoagulation in pregnant women with a history of venous thromboembolism, there is marked variation in the intensity, duration, and monitoring of heparin therapy in pregnant patients. Randomized prospective studies are needed to establish accurate recurrence risks and to evaluate the efficacy of anticoagulation in pregnant women with a history of venous thromboembolism.