DVT and pregnancy

DVT in Pregnancy. What is the treatment of DVT in Pregnancy? Ladies when they are pregnant may develop a deep vein thrombosis. There will be some people who are at a higher risk of having an issue during the time of pregnancy. There will be people who have previously had a deep vein thrombosis. There are some people who have an anatomical abnormality called the May-Thurner syndrome where their left iliac vein is compressed by their right common iliac artery and there will be those ladies who are overweight and these are all people who are at an increased risk of developing a deep vein thrombosis in pregnancy. We often in people in pregnancy who have previously had a deep vein thrombosis we would recommend that they discuss their pregnancy with their obstetrician prior to becoming pregnant or their haematologist or vascular surgeon and the standard recommendation is that if you've previously had a deep vein thrombosis that you would receive molecular weight heparin and often compression stockings during your pregnancy. What is very important to remember if you are giving somebody low molecular weight heparin during their pregnancy is that you then discuss what you're going to do over the time of delivery, but then it is also important that in the postpartum period, i.e. the time after the pregnancy, the consideration is either given to continue the low molecular weight heparin for at least six weeks if not three months postpartum. This is because just post pregnancy the blood in the mother becomes fairly sticky and people are at a greater risk of developing a deep vein thrombosis during that period. Is there any risk of a DVT or a risk of treatment of a DVT to the baby? At the time during the pregnancy it is very important that the right medication is given in terms of somebody if they've got a deep vein thrombosis. There are various drugs that are used for treating deep vein thrombosis. They can either be drugs such as warfarin or low molecular weight heparin or the direct oral anticoagulants. The answer is that warfarin is known to cross the placental barrier and therefore is not recommended for mothers who are pregnant. Low molecular weight heparin is usually the drug of choice which involves either a once or twice daily injection of low-moleculoid heparin during the pregnancy and for a prolonged period of up to six weeks or three months post delivery. The new direct oral anticoagulants so far are not licensed for the use in pregnancy. It is also important just on this to consider those ladies who then go on to breastfeed. Again, we do not make a recommendation to use one of the direct oral anticoagulants. The usual advice is to use low molecular weight heparin and then to actually convert people on to warfarin. And finally, can you prevent the development of a DVT in pregnancy? The answer is that you can in patients who have previously had a deep vein thrombosis, you can reduce their risk of having a subsequent VTE during pregnancy by giving them an appropriate treatment such as low molecular weight heparin. With respect to actually reducing your risk of developing a deep vein thrombosis during pregnancy, it really depends whether you have any previously known risk factors, i.e. abnormal blood, whether you are overweight and there are some thoughts that if you have received some forms of fertility treatment with the injection of various hormones you might be at an increased risk of developing a deep vein thrombosis. So these all need to be considered. Thank you.