Obstetrics & Gynecology>>>>>Medical and Surgical Complications of Pregnancy
Question 6#

A 24-year-old P1001 presents at 8 weeks’ gestation and reports a history of pulmonary embolism 3 years ago during her first pregnancy. She was treated with intravenous heparin followed by several months of oral warfarin (coumadin) and has had no further evidence of thromboembolic disease.

How should her current pregnancy be managed?

A. Since she has had no further events or problems for 3 years, her risk of thromboembolism is no longer increased, and she does not require therapy during this pregnancy
B. Because she has had no problems for 3 years, she may be treated only with a baby aspirin daily
C. She should be managed with Doppler ultrasonography of the bilateral lower extremities once per trimester to screen for deep vein thrombosis
D. The patient should be placed on low-dose unfractionated heparin therapy or low molecular weight heparin therapy throughout pregnancy and puerperium
E. She only requires anticoagulation during the third trimester

Correct Answer is D

Comment:

Pregnancy is considered a hypercoaguable state. Patients with a history of thromboembolic disease in pregnancy are at high risk of developing it in subsequent pregnancies, and therefore should be anticoagulated. Baby aspirin is not considered adequate treatment. Pregnant patients with a history of venous thromboembolism should be treated with either low-dose unfractionated heparin therapy or low molecular weight heparin therapy during the pregnancy and through the postpartum period, as this is the time of highest risk of clot formation. Doppler ultrasonography is the most common way to diagnose a deep vein thrombosis, but is not considered a screening test, and should not be ordered each trimester in the absence of clinical symptoms or signs.