••• Chapter 14^ Management of Medical and Surgical Conditions in Pregnancy^153
❍ Which thrombophilia carries the highest risk of pregnancy-related thromboembolism?
Antithrombin III deficiency, with a risk of up to 40% in women with a history of previous venous
thromboembolism (VTE).
❍ What prophylaxis should be given to women with inherited thrombophilias in pregnancy?
Treatment should be individualized depending on the severity of the thrombophilia and the patient’s personal
history of VTE. In general, a patient with a low-risk thrombophilia with no history of prior VTE can be observed
without prophylactic heparin. Patients with a high-risk thrombophilia with history of 0 to 1 VTE events can be
treated with prophylactic dose of LMWH. In cases of two or more episodes of VTE, therapeutic doses should
be given.
❍ How should women with a history of VTE with no inherited thrombophilia be treated in pregnancy?
Prophylactic dose of LMWH.
❍ How long after delivery can LMWH be restarted?
4 to 6 hours after vaginal delivery or 6 to 12 hours after cesarean delivery.
❍ When should anticoagulant therapy be stopped prior to induction of labor?
24 hours prior.
❍ What is the reversal method for anticoagulant therapy?
Protamine sulfate is given for UFH and fresh frozen plasma for LMWH.
❍ In what case should continuation of Coumadin therapy in pregnancy be considered?
In women with mechanical heart valves due to the greatly increased risk of thrombosis. Most other women on
long-term anticoagulation can be safely switched to LMWH or UFH in pregnancy.
❍ Can women on Coumadin breastfeed?
Coumadin, LMWH, and UFH are all compatible with breastfeeding.
❍ The risk of thromboembolism increases by how much in pregnancy?
Four to fivefold.
❍ What percentage of maternal deaths in developed countries are caused by thromboembolic disease?
9%.
❍ What is the recommended duration of anticoagulant therapy after VTE in pregnancy?
At least 6 months after the first episode. Postpartum treatment should last from 6 weeks to 3 months.
❍ What thromboprophylaxis is recommended for women undergoing cesarean delivery?
Pneumatic compression devices.