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Venous thromboembolic disease and pregnancy

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All pregnant women and those planning to become pregnant, should undergo a risk assessment for venous thromboembolism, writes Suneeta Kochhar

Venous thromboembolism (VTE) encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE).1 According to the Royal College of Obstetricians and Gynaecologists (RCOG), PE continues to be the leading cause of direct maternal death, affecting 1.56 of every 100,000 maternities in the UK. PE is the second most common cause of maternal death overall.

Confidential enquiries into maternal deaths have demonstrated that failure to diagnose VTE and to initiate treatment are contributory factors to maternal death. VTE is more common and more complex to diagnose in pregnant patients compared with those who are not pregnant.2 Fatal PE is the most significant consequence of VTE in pregnancy; however, DVT may result in significant morbidity as a result of post-thrombotic syndrome.

There is an increased risk of VTE from early pregnancy to the postpartum period, with the highest risk being associated with the latter stage. It is likely that the incidence of VTE will increase overall owing to increasing rates of obesity and maternal age older than 35 years.3

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