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Thromboembolic Disease in Pregnancy

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21. 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

22. 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

23. 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

24. 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 Clinical Practice Guidelines Portal

25. Pregnancy in women with Klippel-Trenaunay syndrome: Report of three pregnancies in a single patient and review of literature Full Text available with Trip Pro

Pregnancy in women with Klippel-Trenaunay syndrome: Report of three pregnancies in a single patient and review of literature Klippel-Trenaunay syndrome is characterised by vascular abnormality which increases the risk of thromboembolism and haemorrhage. Physiological changes in pregnancy pose an increased risk to these complications. Being an uncommon disorder, there is limited literature about the management of women with pregnancy and Klippel-Trenaunay syndrome. We report in detail two (...) of three pregnancies in a woman with Klippel-Trenaunay syndrome who had repeated episodes of haematochezia leading to anaemia, managed with Argon laser Photo-Coagulation in pregnancy and also reviewed the complications and the management of pregnant women with Klippel-Trenaunay syndrome.

2017 Obstetric medicine

26. Pregnancy Outcomes in Women With Rheumatic Mitral Valve Disease: Results From the Registry of Pregnancy and Cardiac Disease. Full Text available with Trip Pro

Pregnancy Outcomes in Women With Rheumatic Mitral Valve Disease: Results From the Registry of Pregnancy and Cardiac Disease. Cardiac disease is 1 of the major causes of maternal mortality. We studied pregnancy outcomes in women with rheumatic mitral valve disease.The Registry of Pregnancy and Cardiac Disease is an international prospective registry, and consecutive pregnant women with cardiac disease were included. Pregnancy outcomes in all women with rheumatic mitral valve disease (...) and no prepregnancy valve replacement is described in the present study (n=390). A maternal cardiac event was defined as cardiac death, arrhythmia requiring treatment, heart failure, thromboembolic event, aortic dissection, endocarditis, acute coronary syndrome, and hospitalization for other cardiac reasons or cardiac intervention. Associations between patient characteristics and cardiac outcomes were checked in a 3-level model (patient-center-country).Most patients came from emerging countries (75%). Mitral

2018 Circulation

27. Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism

a miscarriage or having a termination of Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism (NG89) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 7 of 41pregnancy or or if their clinical condition changes and and they: are pregnant or or gave birth, had a miscarriage or had a termination of pregnancy within the past 6 weeks. [2018] [2018] 1.2 Giving (...) in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism (NG89) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 2 of 41Contents Contents Overview 5 Who is it for? 5 Recommendations 6 1.1 Risk assessment 6 1.2 Giving information and planning for discharge 8 1.3 All patients 10 1.4 Interventions for people with acute coronary syndromes or acute stroke or for acutely ill patients 12

2018 National Institute for Health and Clinical Excellence - Clinical Guidelines

28. Cohort study: Women admitted to hospital during pregnancy have increased risk of venous thromboembolism that persists up to 28?days postdischarge

postdischarge Article Text Midwifery Cohort study Women admitted to hospital during pregnancy have increased risk of venous thromboembolism that persists up to 28 days postdischarge Saskia Middeldorp , Suzanne Mariëlla Bleker Statistics from Altmetric.com Commentary on: Abdul Sultan A , West J , Tata LJ , et al . Risk of first venous thromboembolism in pregnant women in hospital: population-based cohort study from England . Implications for practice and research In pregnant women, the risk of venous (...) Cohort study: Women admitted to hospital during pregnancy have increased risk of venous thromboembolism that persists up to 28?days postdischarge Women admitted to hospital during pregnancy have increased risk of venous thromboembolism that persists up to 28 days postdischarge | Evidence-Based Nursing We use cookies to improve our service and to tailor our content and advertising to you. You can manage your cookie settings via your browser at any time. To learn more about how we use cookies

2014 Evidence-Based Nursing

29. Recommendations for the prevention of pregnancy-associated venous thromboembolism

impact of maternal obesity on obstetric practice , Australian and New Zealand Journal of Obstetrics and Gynaecology , 52 , 5 , (409-411) , (2012) . Emily Bain, Agnes Wilson, Rebecca Tooher, Simon Gates, Lucy-Jane Davis and Philippa Middleton , Prophylaxis for venous thromboembolic disease in pregnancy and the early postnatal period , Cochrane Database of Systematic Reviews , 10.1002/14651858.CD001689.pub3 , (2014) . Ida Martinelli, Valerio De Stefano and Pier M. Mannucci , Inherited risk factors (...) Recommendations for the prevention of pregnancy-associated venous thromboembolism Recommendations for the prevention of pregnancy‐associated venous thromboembolism - McLINTOCK - 2012 - Australian and New Zealand Journal of Obstetrics and Gynaecology - Wiley Online Library Search within Search term Search term Opinion Recommendations for the prevention of pregnancy‐associated venous thromboembolism National Women’s Health, Auckland City Hospital, Grafton, Auckland, New Zealand Department

2012 Clinical Practice Guidelines Portal

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

for patients with acute PE and right ventricular dysfunction 24 7 Lower-dose thrombolysis for patients with acute PE and right ventricular dysfunction 24 8 Stockings for preventing post-thrombotic syndrome in patients with DVT 25 Update information 26 Venous thromboembolic diseases: diagnosis, management and thrombophilia testing (CG144) © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 3 of 26This guideline is the basis (...) or likely to spend a substantial proportion of the day in bed or in a chair), pregnancy or puerperium – or in a patient who is having hormonal therapy (oral contraceptive or hormone replacement therapy). Venous thromboembolic diseases: diagnosis, management and thrombophilia testing (CG144) © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 17 of 26Pro Proximal D ximal DVT VT DVT in the popliteal vein or above. Proximal

2012 National Institute for Health and Clinical Excellence - Clinical Guidelines

31. Cohort study: Pregnant women with schizophrenia are at higher risk of pre-eclampsia, venous thromboembolism and adverse neonatal outcomes

in schizophrenic mothers confirm previous findings in the context of newer antipsychotic drugs and treatment practices. Women with schizophrenia should be counselled about increased risks and followed by a provider specialising in high-risk pregnancies. Strategies to address modifiable risk factors during pregnancy and the perinatal period are necessary. Special attention should be given to smoking cessation and control of blood pressure. Novel findings include increased rates of thromboembolic disease (...) Cohort study: Pregnant women with schizophrenia are at higher risk of pre-eclampsia, venous thromboembolism and adverse neonatal outcomes Pregnant women with schizophrenia are at higher risk of pre-eclampsia, venous thromboembolism and adverse neonatal outcomes | Evidence-Based Nursing We use cookies to improve our service and to tailor our content and advertising to you. You can manage your cookie settings via your browser at any time. To learn more about how we use cookies, please see our

2015 Evidence-Based Nursing

32. European guidelines on perioperative venous thromboembolism prophylaxis: Surgery during pregnancy and the immediate postpartum period. (Abstract)

European guidelines on perioperative venous thromboembolism prophylaxis: Surgery during pregnancy and the immediate postpartum period. : Thromboembolic events in the pregnant and postpartum patient remain rare but potentially fatal complications. The aim of this section was to analyse the few prospective studies addressing the issue of thromboprophylaxis following a surgical procedure during and immediately after pregnancy, as well as national guidelines, and to propose European guidelines (...) on this specific condition. Thromboprophylaxis is broadly recommended due to the combined risks of surgery and pregnancy or the postpartum period, regardless of the mode of delivery. We recommend prophylactic thromboprophylaxis following surgery during pregnancy or the postpartum period when they imply, as a consequence, bed rest, until full mobility is recovered (Grade 1C). Similarly, thromboprophylaxis should be used in cases of perioperative infection during pregnancy or the postpartum period. Concerning

2017 European Journal of Anaesthesiology

33. Management of Venous Thromboembolism in Patients with Hereditary Antithrombin Deficiency and Pregnancy: Case Report and Review of the Literature Full Text available with Trip Pro

Management of Venous Thromboembolism in Patients with Hereditary Antithrombin Deficiency and Pregnancy: Case Report and Review of the Literature Background. Hereditary antithrombin deficiency is a thrombogenic disorder associated with a 50-90% lifetime risk of venous thromboembolism (VTE), which is increased during pregnancy and the puerperium in these patients. We present a case of a woman with antithrombin (AT) deficiency who presented with a VTE despite therapeutic low molecular weight (...) heparin (LMWH). Though the pregnancy was deemed unviable, further maternal complications were mitigated through the combined use of therapeutic anticoagulation and plasma-derived antithrombin concentrate infusions to normalize her functional antithrombin levels. Methods. A review of the literature was conducted for studies on prophylaxis and management of VTE in pregnant patients with hereditary AT deficiency. The search involved a number of electronic databases, using combinations of keywords

2017 Case reports in hematology

34. The risk of venous thromboembolism in women with inflammatory bowel diseases during pregnancy and the postpartum period: protocol for systematic review and meta-analysis

The risk of venous thromboembolism in women with inflammatory bowel diseases during pregnancy and the postpartum period: protocol for systematic review and meta-analysis Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites. Email salutation (...) no). For stratified analyses, a minimum number of 8 studies per subgroup is required. ">Subgroup analyses A sensitivity analysis is conducted to assess the impact of decisions taken in the review process on the meta-analysis outcome. These decisions may have been made in various stages of the review, e.g. the decision to exclude certain disease models, the decision to pool certain units of measurement for an outcome, the choice of effect measure, how subgroup variables are stratified etc. In order to assess

2017 PROSPERO

35. Special Topics in Venous Thromboembolism

Patient population: Non-pregnant patients of ages >18 years with suspected or diagnosed venous thromboembolism (VTE), especially those with severe disease, or those with less common clinical scenarios. This document focuses primarily but not exclusively on inpatient, observation, and emergency department services for patients with suspected or diagnosed VTE. Note: In-depth coverage of the standard diagnosis and management of VTE is provided in the ambulatory venous thromboembolism guideline (...) syndrome requires confirmation with positive repeat testing in 12 weeks ** For mesenteric venous thrombosis, causes of local inflammation may include active inflammatory bowel disease, acute pancreatitis, appendicitis, diverticulitis, peritonitis. JAK2: Janus kinase 2 gene mutation 9 Michiga n Medici n e Special Topics in Veno us Thr o m boe mboli s m Guid eline 2/ 201 9 Table 6. Indications and Contraindications for Systemic Thrombolytic Therapy with Alteplase in Higher-Risk Acute PE Indications

2020 University of Michigan Health System

36. Venous Thromboembolism (VTE)

(most common) • Factor V Leiden mutation • Prothrombin gene mutation • Protein S deficiency • Protein C deficiency • Antithrombin deficiency Antiphospholipid antibody syndrome (APS) Congestive heart failure Myeloproliferative disorders • Polycythemia vera • Essential thrombocytosis Inflammatory bowel disease Nephrotic syndrome Hyperhomocysteinemia Paroxysmal nocturnal hemoglobinuria Sources: UpToDate 2013 Bauer, Lip (literature review through May2013) 3 UMHS Venous Thromboembolism Guideline Update (...) , May 2014 Table 1. Glossary of Abbreviations aPTT Activated Partial Thromboplastin Time APS Antiphospholipid antibody syndrome ABGs Arterial Blood Gases BNP B-type natriuretic peptide CVA Cerebrovascular accident CTEPH Chronic thromboembolic pulmonary hypertension CTA Computed tomography angiography CTV Computed tomographic venography COCs Estrogen-containing combined oral contraceptives DVT Deep venous thrombosis GSV Great saphenous vein HIT Heparin-induced thrombocytopenia HRT Hormone replacement

2020 University of Michigan Health System

37. Obesity in Pregnancy

the issue of weight loss before conception. Women should be encouraged to enter pregnancy with a BMI < 30 kg/m 2 , and ideally < 25 kg/m 2 (III-B). 2. BMI should be calculated from pre-pregnancy height and weight. Those with a pre-pregnancy BMI > 30 kg/m 2 are considered obese. This information can be helpful in counselling women about pregnancy risks associated with obesity (II-2B). 3. Obese pregnant women should receive counselling about weight gain, nutrition, and food choices (II-2B). 4. Obese women (...) should be advised that they are at risk for medical complications such as cardiac disease, pulmonary disease, gestational hypertension, gestational diabetes, and obstructive sleep apnea. Regular exercise during pregnancy may help to reduce some of these risks (II-2B). 5. Obese women should be advised that their fetus is at an increased risk of congenital abnormalities, and appropriate screening should be done (II-2B). 6. Obstetric care providers should take BMI into consideration when arranging

2018 Society of Obstetricians and Gynaecologists of Canada

38. Pregnancy

rupture, increased risk of venous thromboembolism. Fetal — possible higher incidence of low birthweight babies (if hyperemesis gravidarum). Conditions causing nausea and vomiting in pregnancy include: Genito-urinary conditions such as urinary tract infection, pyelonephritis, ovarian torsion. Endocrine conditions 2013 18. Interventions for preventing recurrent urinary tract infection during pregnancy . BACKGROUND: Recurrent urinary tract infections (RUTI) are common in women who are pregnant and may (...) -eclampsia. Anaemia. Down's syndrome. Haemoglobinopathies (sickle cell disease and thalassaemia 2016 3. Management of Cardiovascular Diseases during Pregnancy We use cookies to enhance your experience on our website. By continuing to use our website, you are agreeing to our use of cookies. You can change your cookie settings at any time. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy | European Heart Journal | Oxford Academic Search Account Menu Menu Navbar Search

2018 Trip Latest and Greatest

39. What Is the Best Imaging Study to Rule Out Pulmonary Embolism in Pregnancy? (SRS diagnosis)

relevant articles. The search strategy included 3 sets of search terms including the condition (pulmonary embolism andvenous thromboembolism), the subjects (pregnant patients), and the index tests. No language ?lters were applied. STUDY SELECTION Prospective and retrospective studies with consecutive patient enrollment with at least 25 subjects in which the provider suspected pulmonary embolism in pregnant patients were included. The Quality Assessment of Diagnostic Accuracy Studies-2 1 tool was used (...) What Is the Best Imaging Study to Rule Out Pulmonary Embolism in Pregnancy? (SRS diagnosis) What Is the Best Imaging Study to Rule Out Pulmonary Embolism in Pregnancy? TAKE-HOME MESSAGE Both computed tomography (CT) pulmonary angiography and lung scintigraphy (ie, ventilation-perfusion scan) are appropriate imaging options for exclusion of pulmonary embolism during pregnancy. EBEM Commentators Latha Ganti, MD, MBA David Lebowitz, MD Department of Clinical Sciences University of Central Florida

2018 Annals of Emergency Medicine Systematic Review Snapshots

40. Care of Women with Obesity in Pregnancy

. Reducing the Risk of Venous Thromboembolic Disease in Pregnancy and the Puerperium: Acute Management. Green-top Guideline No. 37b. London: RCOG; 2015. 100. Ismail SK, Norris L, O’Shea S, Higgins JR. Weight-adjusted LMWH prophylaxis provides more effective thrombin inhibition in morbidly obese pregnant women. Thromb Res 2014;134:234–9. 101. Overcash RT, Somers AT, LaCoursiere DY. Enoxaparin dosing after cesarean delivery in morbidly obese women. Obstet Gynecol 2015;125:1371–6. 102. Molyneaux E, Poston L (...) thromboembolism (VTE) during pregnancy. B Risk assessment should be individually discussed, assessed and documented at the ?rst antenatal visit, during pregnancy (if admitted or develop intercurrent problems), intrapartum and postpartum. Antenatal and post-birth thromboprophylaxis should be considered in accordance with the RCOG GTG No. 37a. D RCOG Green-top Guideline No. 126 e66 of e106 ª 2018 Royal College of Obstetricians and GynaecologistsAcute VTE in pregnant women with obesity should be treated

2018 Royal College of Obstetricians and Gynaecologists

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