USMLE Step 2 CK Lecture Notes 2019: Obstetrics/Gynecology (Kaplan Test Prep)

For anticoagulation medications, use the following guidelines:

Antepartum: Use LMWH from first trimester to 36 weeks; then at 36 weeks
transition to UFH until delivery.

Intrapartum

Postpartum

levels

Disadvantages:  cannot  use orally, higher  cost,   can not be  reversed

Warfarin    (Coumadin)  can be  used    only    postpartum.

Advantages: oral    administration, long    half-life,  inexpensive,    OK  for

breast  feeding

Disadvantages:  crosses placenta,   needs   monitoring  with    INR 

None    or  prophylactic    dose

Low-risk    thrombophilia   without VTE episode

Prophylactic    or  intermediate-dose

Low-risk    thrombophilia   with    single  VTE episode

High-risk   thrombophilia   without VTE episode

Therapeutic dose

High-risk   thrombophilia   with    single  VTE episode

Any thrombophilia   with    VTE in  current pregnancy

Discontinue UFH during  immediate   peripartum  interval    to  decrease    risk    of

hemorrhage  and permit  regional    anesthesia.

Protamine   sulfate can be  used    to  reverse UFH effect.

VTE risk    increased   20-fold in  the first   week    postpartum.