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Thromboembolic Disease in Pregnancy

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1. Venous thromboembolic diseases: diagnosis, management and thrombophilia testing

#notice-of-rights). Page 4 of 47This guideline replaces CG144. This guideline is the basis of QS29. Overview Overview This guideline covers diagnosing and managing venous thromboembolic diseases in adults. It aims to support rapid diagnosis and effective treatment for people who develop deep vein thrombosis (DVT) or pulmonary embolism (PE). It also covers testing for conditions that can make a DVT or PE more likely, such as thrombophilia (a blood clotting disorder) and cancer. The guideline does (...) Venous thromboembolic diseases: diagnosis, management and thrombophilia testing Venous thromboembolic diseases: diagnosis, management and thrombophilia testing NICE guideline Published: 26 March 2020 www.nice.org.uk/guidance/ng158 © NICE 2020. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-of- rights).Your responsibility Your responsibility The recommendations in this guideline represent the view of NICE, arrived at after careful

2020 National Institute for Health and Clinical Excellence - Clinical Guidelines

2. American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy Full Text available with Trip Pro

American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy Venous thromboembolism (VTE) complicates ∼1.2 of every 1000 deliveries. Despite these low absolute risks, pregnancy-associated VTE is a leading cause of maternal morbidity and mortality.These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians and others in decisions about the prevention (...) and management of pregnancy-associated VTE.ASH formed a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used

2018 Blood advances

4. Management of venous thromboembolism secondary to ovarian hyperstimulation syndrome: A case report documenting the first use of a superior vena caval filter for upper limb venous thromboembolism in pregnancy, and the difficulties and complications relatin Full Text available with Trip Pro

Management of venous thromboembolism secondary to ovarian hyperstimulation syndrome: A case report documenting the first use of a superior vena caval filter for upper limb venous thromboembolism in pregnancy, and the difficulties and complications relatin The management of venous thromboembolism and subsequent pulmonary embolism in pregnancy remains hugely challenging. In this case, we report the first use of a superior vena caval filter in pregnancy as an adjunct to pharmacological (...) anticoagulation. This is the first reported use of a superior vena caval filter in pregnancy. We discuss the complexities of managing thromboembolism in pregnancy and the peri-partum period.

2016 Obstetric medicine

5. Pregnancy and Renal Disease

dominant and recessive forms of polycystic kidney disease, Alport syndromes, Fabry disease and Cystinosis (1) and this option might be a consideration for some families. References 1. Human Fertilisation and Embryology Authority. Pre-implantation genetic diagnosis. 2019. Available at: https://www.hfea.gov.uk/pgd-conditions/ (accessed 22 nd May 2019). Guideline 3.3.4 We recommend pre-pregnancy counselling for the optimisation of maternal and neonatal outcomes in women with CKD, which may include (...) was assigned as ‘strong’ (‘we recommend...’) or conditional (‘we suggest...’) based on a threshold of 75% of respondents agreeing with the recommendation, and where benefits outweigh risks for most, if not all patients. Renal Association Clinical Practice Guideline Pregnancy and Renal Disease – September 2019 3 Table of Contents 1. Introduction 4 2 Summary of clinicial practice guidelines 7 3. Summary of audit measures 17 4. Summary of research recommendations 18 5. Rationale for clinical practice

2019 Renal Association

6. Management of Cardiovascular Diseases during Pregnancy Full Text available with Trip Pro

, maternal heart disease is the major cause of maternal death during pregnancy. , Hypertensive disorders are the most frequent cardiovascular disorders during pregnancy, occurring in 5–10% of all pregnancies (see section 10). Among the other disease conditions, congenital heart disease is the most frequent CVD present during pregnancy in the western world (75–82%). , Rheumatic valvular disease dominates in non-western countries, comprising 56–89% of all CVDs in pregnancy. , Peripartum intensive care unit (...) ratio ACS Acute coronary syndromes AF Atrial fibrillation AHF Acute heart failure AMI Acute myocardial infarction aPTT Activated partial thromboplastin time ARB Angiotensin receptor blocker ARNI Angiotensin receptor neprilysin inhibitor AS Aortic stenosis ASD Atrial septal defect ASI Aortic size index AT Atrial tachycardia AUC Area under the curve AV Atrioventricular BMI Body mass index BP Blood pressure BSA Body surface area CAD Coronary artery disease CARPREG CARdiac disease in PREGnancy CCB

2018 European Society of Cardiology

7. Venous thromboembolic and bleeding complications among pregnant women with Klippel-Trenaunay syndrome. (Abstract)

Venous thromboembolic and bleeding complications among pregnant women with Klippel-Trenaunay syndrome. Klippel-Trenaunay Syndrome (KTS) is a vascular malformation overgrowth syndrome characterized by capillary malformation, venous malformation and limb overgrowth, +/- lymphatic malformation. Patients are at an increased risk of hemorrhage and venous thromboembolism (VTE). Consequently, women with this condition often are counseled to avoid pregnancy, but there is minimal data available (...) on the relationship between pregnancy, VTE and bleeding risk.To review the risk of VTE and bleeding in pregnant and nulligravid women with KTS.A retrospective chart review of women with KTS, ≥18-years, evaluated at Mayo Clinic Rochester, MN from August 1945 to April 2018, was performed.Seventy-five women with ≥1 pregnancy and 64 nulligravid women were identified. VTE prevalence was 14/70 (20%) for women with a history of pregnancy and 16/64(25%) for nulligravid women (p = 0.93). Among the 70 women with a history

2019 Journal of American Academy of Dermatology

8. Inflammatory Bowel Disease in Pregnancy Clinical Care Pathway: A Report From the American Gastroenterological Association IBD Parenthood Project Working Group Full Text available with Trip Pro

Clinical Care Pathway. LARC, long-acting, reversible contraception. Figure 2 Pregnancy planning and conception. ACOG, American College of Obstetricians and Gynecologists; LARC, long-acting, reversible contraception. Figure 3 Nine-month plan. Figure 4 Decision algorithm for mode of delivery. GBS, group B streptococcus; VTE, venous thromboembolism. Figure 5 Post-delivery care for mother and baby. AAP, American Academy of Pediatrics; ASQ, Ages and Stages Questionnaire; CDC, Centers for Disease Control (...) Inflammatory Bowel Disease in Pregnancy Clinical Care Pathway: A Report From the American Gastroenterological Association IBD Parenthood Project Working Group Inflammatory Bowel Disease in Pregnancy Clinical Care Pathway: A Report From the American Gastroenterological Association IBD Parenthood Project Working Group - Gastroenterology Email/Username: Password: Remember me Search AGA Journals Search Terms Search within Search To read this article in full, please review your options for gaining

2019 American Gastroenterological Association Institute

9. Inflammatory bowel disease and venous thromboembolism during pregnancy and the postpartum period. Full Text available with Trip Pro

The incidence of inflammatory bowel disease (IBD) increases, and thus is more common, in pregnant women. IBD is a risk factor for venous thromboembolism (VTE) but it is not clear whether IBD predisposes women to an excess risk of VTE during pregnancy and the postpartum period. Methods This was a nationwide population-based cohort study of all deliveries during 1980-2013 in Denmark, using data from two nationwide health registries: the Danish National Patient Registry and the Medical Birth Registry. We (...) Inflammatory bowel disease and venous thromboembolism during pregnancy and the postpartum period. Essentials Risk of pregnancy-related venous thromboembolism may be increased in inflammatory bowel disease. We performed a study on inflammatory bowel disease and pregnancy-related venous thromboembolism. Inflammatory bowel disease is a risk factor for pregnancy-related venous thromboembolism. Proper disease control before conception is pivotal to avoid venous thromboembolism.Background

2017 Journal of Thrombosis and Haemostasis

10. Prevention of Venous Thromboembolic Disease in Colorectal Surgery

Prevention of Venous Thromboembolic Disease in Colorectal Surgery Copyright © The American Society of Colon & Rectal Surgeons, Inc. Unauthorized reproduction of this article is prohibited. 14 DISEASES OF THE COLON & RECTUM VOLUME 61: 1 (2018) T he American Society of Colon and Rectal Surgeons is dedicated to ensuring high-quality patient care by advancing the science, prevention, and manage- ment of disorders and diseases of the colon, rectum, and anus. The Clinical Practice Guidelines (...) methods using ultrasound and venography for diagnosis showed the rate of proximal DVT, defined as popliteal or more proximal veins, to be 2.6% to 2.8%. 3 Population-based studies have also tried to estimate the risk of DVT after colorectal surgery, although the lack of a The American Society of Colon and Rectal Surgeons Clinical Practice Guideline for the Prevention of Venous Thromboembolic Disease in Colorectal Surgery Fergal Fleming, M.D. • Wolfgang Gaertner, M.D. • Charles A. T ernent M.D. Emily

2018 American Society of Colon and Rectal Surgeons

11. Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Suspected Acute Venous Thromboembolic Disease

Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Suspected Acute Venous Thromboembolic Disease ACEP // Acute Venous Thromboembolic Disease Popular Recommendations PEER ultrasound LLSA sepsis Log In Log In Topics Practice Education Advocacy About ACEP Topics TOPICS Quick Access Current News Practice Administration Life as a Physician Patient Care By Medical Focus Education In Education Bedside Tools Upcoming Conferences Earn CME Now (...) SERVE WHAT WE BELIEVE / / Acute Venous Thromboembolic Disease Acute Venous Thromboembolic Disease Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Suspected Acute Venous Thromboembolic Disease Scope of Application. This guideline is intended for physicians working in emergency departments (EDs). Inclusion Criteria. This guideline is intended for adult patients presenting to the ED with suspected or known acute venous thromboembolism (ie

2018 American College of Emergency Physicians

12. Incidence of Pulmonary and Venous Thromboembolism in IVF Pregnancies After Fresh and Frozen Embryo Transfer

whether the risk of pulmonary embolism and venous thromboembolism during the first trimester of IVF pregnancies is associated with both fresh and frozen embryo transfer. A population-based cohort study with linked data from nationwide registries on women in Sweden giving birth to their first child 1992-2012 Condition or disease Intervention/treatment Assisted Reproductive Techniques Pregnancy Pulmonary Embolism Venous Thromboembolism Fresh Embryo Transfer Frozen Embryo Transfer Procedure: Fresh (...) -regulated Device Product: No Keywords provided by Peter Henriksson, Karolinska Institutet: In vitro fertilization Assisted Reproductive Techniques Pulmonary embolism Venous Thromboembolism Pregnancy Additional relevant MeSH terms: Layout table for MeSH terms Thromboembolism Embolism Venous Thromboembolism Pulmonary Embolism Embolism and Thrombosis Vascular Diseases Cardiovascular Diseases Lung Diseases Respiratory Tract Diseases

2018 Clinical Trials

13. ACOG Practice Bulletin No. 196 Summary: Thromboembolism in Pregnancy. (Abstract)

ACOG Practice Bulletin No. 196 Summary: Thromboembolism in Pregnancy. Women who are pregnant or in the postpartum period have a fourfold to fivefold increased risk of thromboembolism compared with nonpregnant women (1, 2). Approximately 80% of thromboembolic events in pregnancy are venous (3), with a prevalence of 0.5-2.0 per 1,000 pregnant women (4-9). Venous thromboembolism (VTE) is one of the leading causes of maternal mortality in the United States, accounting for 9.3% of all maternal (...) deaths (10).The prevalence and severity of this condition during pregnancy and the peripartum period warrant special consideration of management and therapy. Such therapy includes the treatment of acute thrombotic events and prophylaxis for those at increased risk of thrombotic events. The purpose of this document is to provide information regarding the risk factors, diagnosis, management, and prevention of thromboembolism, particularly VTE in pregnancy. This Practice Bulletin has been revised

2018 Obstetrics and Gynecology

14. ACOG Practice Bulletin No. 196: Thromboembolism in Pregnancy. (Abstract)

ACOG Practice Bulletin No. 196: Thromboembolism in Pregnancy. Women who are pregnant or in the postpartum period have a fourfold to fivefold increased risk of thromboembolism compared with nonpregnant women (). Approximately 80% of thromboembolic events in pregnancy are venous (), with a prevalence of 0.5-2.0 per 1,000 pregnant women (). Venous thromboembolism (VTE) is one of the leading causes of maternal mortality in the United States, accounting for 9.3% of all maternal deaths (...) ().The prevalence and severity of this condition during pregnancy and the peripartum period warrant special consideration of management and therapy. Such therapy includes the treatment of acute thrombotic events and prophylaxis for those at increased risk of thrombotic events. The purpose of this document is to provide information regarding the risk factors, diagnosis, management, and prevention of thromboembolism, particularly VTE in pregnancy. This Practice Bulletin has been revised to reflect updated

2018 Obstetrics and Gynecology

15. Pregnancy and Risk of Venous Thromboembolism

for VTE into consideration and that aids the decision-making process of antenatal anti-thrombotic prophylaxis. This study will personalize care using a score to individually assess the risk and propose appropriate prevention. The main objective of this study is to conduct a medico-economic study to evaluate the efficiency of an innovative strategy integrating the Lyon-VTE-score in the management of pregnant patients with venous thromboembolism risk versus standard care. Condition or disease (...) by (Responsible Party): Hospices Civils de Lyon Study Details Study Description Go to Brief Summary: The management of venous thromboembolism (VTE) risk in pregnancy still remains a challenge. An individual assessment of the VTE risk is crucial for optimal thromboprophylaxis, but there is no validated tool to help clinicians stratify the risk in pregnant women and introduce prophylactic anticoagulation at the appropriate time. Recommendations mostly based on case-control studies and expert opinions do

2018 Clinical Trials

16. Management of Pregnancy in Patients With Complex Congenital Heart Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association Full Text available with Trip Pro

Repaired coarctation III Significantly increased maternal mortality or severe morbidity risk. Expert counseling required. In the event of pregnancy, intensive specialist cardiac and obstetric monitoring needed throughout pregnancy, childbirth, and the puerperium. Mechanical valve Systemic RV Fontan circulation Cyanotic heart disease (unrepaired) Other complex CHD Aortic dilation 40–45 mm in Marfan syndrome Aortic dilation 45–50 mm in bicuspid aortic valve aortopathy IV Extremely high maternal mortality (...) scores have significant limitations, however, because they are highly population dependent. For example, Canadian Cardiac Disease in Pregnancy included 22% of patients with acquired heart disease, and 4% of the population were included because of arrhythmias. Therefore, in an effort to prevent high-risk patients from becoming pregnant, including those with severe pulmonary hypertension and severely dilated aortas and those who are not represented in these studies, a prepregnancy counseling session

2017 American Heart Association

17. Thromboembolic Disease in Pregnancy

Thromboembolic Disease in Pregnancy Thromboembolic Disease in Pregnancy Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Thromboembolic (...) Disease in Pregnancy Thromboembolic Disease in Pregnancy Aka: Thromboembolic Disease in Pregnancy , Deep Vein Thrombosis in Pregnancy , Deep Venous Thrombosis During Pregnancy , DVT in Pregnancy , DVT Prophylaxis in Pregnancy II. Epidemiology Venous Thrombosis risk: 0.5 to 3 per 1000 pregnancies risk is increased 5 fold in pregnancy DVT occurs equally in all trimesters (but increases with each trimester and especially postpartum) III. Pathophysiology Hypercoagulation in pregnancy Procoagulants

2018 FP Notebook

18. Flowchart: Venous thromboembolism (VTE) prophylaxis in pregnancy and the puerperium, Postnatal assessment and management

prophylaxis for 5 days • Consider IPC if hospitalised Antenatal therapeutic anticoagulation Postnatal therapeutic anticoagulation Socio-demographic • Age = 35 years • BMI = 30 kg/m 2 • Cigarette smoker (>10/day) Medical history • Asymptomatic thrombophilia (inherited or acquired) • Family history VTE + weak thrombophilia • Systemic lupus erythematosus • Cardiac or lung disease • Sickle cell disease • Gross varicose veins • Inflammatory conditions • Nephrotic syndrome • Cancer • Pre-existing diabetes (...) Flowchart: Venous thromboembolism (VTE) prophylaxis in pregnancy and the puerperium, Postnatal assessment and management Great state. Great opportunity. Department of Health State of Queensland (Queensland Health) 2014 http://creativecommons.org/licenses/by-nc-nd/3.0/au/deed.en Queensland Clinical Guidelines, Guidelines@health.qld.gov.au Postnatal assessment and management of VTE prophylaxis High Risk Factors • Antenatal LMWH prophylaxis (refer to antenatal VTE prophylaxis flow chart) • Any

2014 Queensland Health

19. Flowchart: Venous thromboembolism (VTE) prophylaxis in pregnancy and the puerperium, Antenatal assessment and management

• Cigarette smoker (>10/day) Medical history • Systemic lupus erythematosus • Cardiac or lung disease • Sickle cell disease • Gross varicose veins • Inflammatory conditions • Nephrotic syndrome • Cancer • Pre-existing diabetes • Ovarian hyperstimulation Pregnancy related • Immobility (e.g. bed rest, long distance travel) • Preeclampsia/eclampsia • Artificial reproductive therapy • Gestational diabetes • Multiparity (> 2) • Multiple pregnancy • Intrauterine growth restriction • Hyperemesis/dehydration (...) Flowchart: Venous thromboembolism (VTE) prophylaxis in pregnancy and the puerperium, Antenatal assessment and management Great state. Great opportunity. Department of Health State of Queensland (Queensland Health) 2014 http://creativecommons.org/licenses/by-nc-nd/3.0/au/deed.en Queensland Clinical Guidelines, Guidelines@health.qld.gov.au Antenatal assessment and management of VTE prophylaxis High Risk Factors • Single prior unprovoked VTE • Single prior VTE pregnancy or COCP related • Single

2014 Queensland Health

20. Venous thromboembolism (VTE) prophylaxis in pregnancy and the puerperium

if hospitalised • Consider # LMWH prophylaxis Pre-pregnancy therapeutic anticoagulation Antenatal therapeutic anticoagulation Socio-demographic • Age = 35 years • BMI = 30 kg/m 2 • Cigarette smoker (>10/day) Medical history • Systemic lupus erythematosus • Cardiac or lung disease • Sickle cell disease • Gross varicose veins • Inflammatory conditions • Nephrotic syndrome • Cancer • Pre-existing diabetes • Ovarian hyperstimulation Pregnancy related • Immobility (e.g. bed rest, long distance travel (...) • Cigarette smoker (>10/day) Medical history • Asymptomatic thrombophilia (inherited or acquired) • Family history VTE + weak thrombophilia • Systemic lupus erythematosus • Cardiac or lung disease • Sickle cell disease • Gross varicose veins • Inflammatory conditions • Nephrotic syndrome • Cancer • Pre-existing diabetes • Antiphospholipid antibodies Birth • Emergency CS in labour • Elective CS • Prolonged labour (> 24 hrs) • Operative vaginal birth • Stillbirth • Preterm birth • Postpartum haemorrhage

2014 Queensland Health

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