Most viewed procedures

Venous Thromboembolism (VTE) remains an important cause of maternal morbidity and mortality in Canada. VTE is at least 5 times more common in pregnant than in non-pregnant women. The greatest increase in risk is in the postpartum period. Postpartum pulmonary embolism (PE) is a leading cause of maternal mortality in Canada, with up to 17 maternal deaths each year. The “per day” risk is 15- to 35-fold greater in the 6 weeks following delivery than in non-pregnant age-matched patients, with the highest risk being in the first 3 weeks postpartum.  Because there are no large trials of routine low molecular weight heparin (LMWH) prophylaxis in postpartum patients, the best practice guidelines are largely based on extrapolated data from other patient populations and expert opinion. In populations of general, orthopedic and gynecologic patients it has been repeatedly shown that VTE prophylaxis significantly decreases the incidence of post-operative PE without increasing significant bleeding complications. The suggested algorithms and protocols provide guidance for the management of thromboprophylaxis in obstetrical patients, but do not replace clinical judgment in the decision to initiate or continue thromboprophylaxis. Indeed, the optimal management strategy, expected net clinical benefits, risk of VTE associated with each risk factor and interactions between risk factors are currently unknown. Definitions: Thrombophlebitis: Inflammation of the wall of a vein leading to clot (thrombus) formation at the site of the inflammation. Deep Vein Thrombosis (DVT): Thrombus formation in the deep veins, usually of the lower extremity but occasionally in the pelvic veins. Venous thromboembolism: A term that includes DVT and embolism of a thrombus that breaks free from venous thrombosis and travels to another organ, usually the lung. Post-thrombotic leg syndrome: leg pain, swelling, dermatitis, and ulcers caused by permanent damage to leg vein valves from prior DVT. Pulmonary Embolism: transport of a thrombus, usually from a DVT, through the venous circulation and heart to the pulmonary circulation where it becomes trapped. Small emboli lodge in small lung vessels and can dissolve spontaneously. Larger emboli can lead to cardiopulmonary failure and death. Low molecular weight heparin: a fractionated heparin given subcutaneously for VTE prophylaxis or therapy. It has a better side effect profile than unfractionated heparin and does not require platelet monitoring; however, it is more difficult to reverse reliably with protamine, as compared to unfractionated heparin.