Prevention and Treatment of Venous Thromboembolism in Pregnancy

Pregnancy and the postpartum period are associated with an increased risk of deep vein thrombosis and pulmonary embolism and venous thromboembolism is a cause of significant morbidity and mortality globally. The diagnosis, prevention, and management of pregnancy-related venous thromboembolism is complicated by the need to consider fetal, as well as maternal, well-being and the limited high-quality data available to clinicians. Compression ultrasonography remains the recommended initial test for evaluation of suspected deep vein thrombosis in pregnancy, but recent studies suggest that the use clinical prediction rules with D-dimer testing can reduce the need for radiologic imaging in pregnant patients with suspected pulmonary embolism. Low molecular weight heparin remains the preferred anticoagulant for prevention and treatment of pregnancy-related venous thromboembolism. Anticoagulant management at delivery should involve a multidisciplinary approach that emphasizes shared decision making.