Coagulation & Thromboembolic Diseases During Pregnancy - PDF

Coagulation disorders and thromboembolic diseases during pregnancy Amal Mubarak MBChB.FICOG. CABOG Gynecology Block  Objectives To review normal physiological changes of coagulation system during pregnancy To understand acquired and inherit...

Coagulation disorders and thromboembolic diseases during pregnancy Amal Mubarak MBChB.FICOG. CABOG Gynecology Block  Objectives To review normal physiological changes of coagulation system during pregnancy To understand acquired and inherited types of coagulation disorders To realize the management during antenatal, intrapartum and postpartum periods To accurately manage patients with or at risk of thromboembolic diseases. To know the impact of these diseases on reproductive outcome. Thrombocytopaenia Thrombocytopaenia is defined as a platelet count preferred option where *a rapid platelet increase is required close to term, *if the duration of treatment is likely to be prolonged or if unacceptably high maintenance doses of prednisolone are required. - expensive but highly effective Gestational (incidental) thrombocytopenia Autoimmune thrombocytopenia (ITP): found in 7-8% of pregnancy. 1/5000 There is mild fall of platelets count (100-150 000/ml), Usually occurs in late pregnancy It can occur at any stage of with no prior history outside pregnancy. pregnancy. No intervention is required other Management during pregnancy Serial monitoring of platelets level. than platelets count monitoring Treatment considered if count falls below during pregnancy. 50*109/L near term by : No risk of fetal thrombocytopenia. There is 5-10% risk of fetal thrombocytopenia. Resolved spontaneously after delivery.. Maternal haemorrhage at delivery is likely if the platelet count is less than 50 × 109 /l spontaneous bleeding during pregnancy very unlikely if the platelet count is >20 × 109 /l Vaginal delivery should be facilitated regional anaesthesia avoided if the platelet count is 90 bpm) with a mild pyrexia (37.5°C). Rarely, massive PE may present with sudden cardiorespiratory collapse CT pulmonary angiogram is the gold standard investigation. ventilation perfusion (V/Q) scan (ECG), chest X-ray and arterial blood gases should be performed to exclude other respiratory diagnose D-dimer?????? Treatment : Multidisplinary team,call for help,ABC,IV UFH is preferred in acute stage. Thrombolysis with streptokinase is reversed for unstable patient (risk of bleeding). Surgical embolectomy.