Central European Journal of Medicine

, Volume 8, Issue 5, pp 548–552 | Cite as

Venous thromboembolism in pregnant woman — a challenge for the clinician

  • Camelia C. Diaconu
  • Alice Bălăceanu
  • Daniela Bartoş


Deep vein thrombosis and pulmonary embolism are two clinical entities of a single disease called venous thromboembolism. Venous thromboembolism is an important cause of maternal morbidity and mortality. Diagnosis and treatment of venous thromboembolism in pregnant women are much more difficult than in non-pregnant women. Pregnant patients were excluded from all major clinical trials investigating therapeutic combinations for acute thromboembolism. Although, for many years, the standard anticoagulant during pregnancy and postpartum was unfractionated heparin, current guidelines recommend low molecular weight heparin. The advantages of low molecular weight heparin are lower risk of bleeding, predictable pharmacokinetics, lower risk of fracture because of thrombocytopenia and heparin-induced osteoporosis.


Thromboembolism Pregnancy Anticoagulation 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. [1]
    Centre for Maternal and Child Enquiries (CMACE). Saving Mothers’ Lives. Reviewing maternal deaths to make motherhood safer: 2006–2008. BJOG 2011; 118(Suppl.), 1–203Google Scholar
  2. [2]
    EUROPERISTAT Project, SCPE EUROCAT, EURONEOSTAT. European perinatal health report.
  3. [3]
    Sullivan EA, Ford JB, Chambers G, Slaytor E. Maternal mortality in Australia, 1973–1996. Aust N Z J Obstet Gynaecol 2004; 44: 452–457PubMedCrossRefGoogle Scholar
  4. [4]
    James AH, Bushnell CD, Jamison MG, Myers ER. Incidence and risk factors for stroke in pregnancy and the puerperium. Obstet Gynecol. 2005; 106: 509–516PubMedCrossRefGoogle Scholar
  5. [5]
    James AH, Jamison MG, Biswas MS, Brancazio LR, Swamy GK, Myers ER. Acute myocardial infarction in pregnancy: a United States populationbased study. Circulation. 2006; 113: 1564–1571PubMedCrossRefGoogle Scholar
  6. [6]
    Heit JA, Kobbervig CE, James AH, Petterson TM, Bailey KR, Melton LJ. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Intern Med. 2005; 143: 697–706PubMedCrossRefGoogle Scholar
  7. [7]
    Zotz RB, Gerhardt A, Scharf RE. Prediction, prevention and treatment of venous thromboembolic disease in pregnancy. Semin Thromb Hemost. 2003; 29(2):143–154PubMedCrossRefGoogle Scholar
  8. [8]
    Brill-Edwards P, Ginsberg JS, Gent M, et al. Safety of withholding heparin in pregnant women with a history of venous thromboembolism. Recurrence of Clot in This Pregnancy Study Group. N Engl J Med. 2000; 343: 1439–1444PubMedCrossRefGoogle Scholar
  9. [9]
    Pabinger I, Grafenhofer H, Kaider A, et al. Risk of pregnancy-associated recurrent venous thromboembolism in women with a history of venous thrombosis. J Thromb Haemost. 2005; 3: 949–954PubMedCrossRefGoogle Scholar
  10. [10]
    De Stefano V, Martinelli I, Rossi E, et al. The risk of recurrent venous thromboembolism in pregnancy and puerperium without antithrombotic prophylaxis. Br J Haematol. 2006; 135: 386–391PubMedCrossRefGoogle Scholar
  11. [11]
    Sanson BJ, Lensing AW, Prins MH, et al. Safety of low-molecular-weight heparin in pregnancy: a systematic review. Thromb Haemost. 1999; 81: 668–672PubMedGoogle Scholar
  12. [12]
    Lepercq J, Conard J, Borel-Derlon A, et al. Venous thromboembolism during pregnancy: a retrospective study of enoxaparin safety in 624 pregnancies. Bjog. 2001; 108: 1134–1140PubMedGoogle Scholar
  13. [13]
    James AH, Jamison MG, Brancazio LR, Myers ER. Venous thromboembolism during pregnancy and the postpartum period: incidence, risk factors, and mortality. Am J Obstet Gynecol. 2006; 194: 1311–1315PubMedCrossRefGoogle Scholar
  14. [14]
    American College of Obstetricians and Gynecologists. Thromboembolism in pregnancy. ACOG Practice Bulletin No. 19. Obstet Gynecol. 2000; 96(2): 1–10Google Scholar
  15. [15]
    Gherman RB, Goodwin TM, Leung B, Byrne JD, Hethumumi R, Montoro M. Incidence, clinical characteristics, and timing of objectively diagnosed venous thromboembolism during pregnancy. Obstet Gynecol. 1999; 94(5 pt 1): 730–734PubMedCrossRefGoogle Scholar
  16. [16]
    Qaseem A, Snow V, Barry P, et al, for the Joint American Academy of Family Physicians/American College of Physicians Panel on Deep Venous Thrombosis/Pulmonary Embolism. Current diagnosis of venous thromboembolism in primary care: a clinical practice guideline from the American Academy of Family Physicians and the American College of Physicians. Ann Intern Med. 2007; 146(6): 454–458PubMedCrossRefGoogle Scholar
  17. [17]
    Michiels JJ, Freyburger G, van der Graaf F, Janssen M, Oortwijn W, Van Beek E. Strategies for the safe and effective exclusion and diagnosis of deep vein thrombosis by the sequential use of clinical score, D-dimer testing, and compression ultrasonography. Semin Thromb Hemost. 2000; 26(6): 657–667PubMedCrossRefGoogle Scholar
  18. [18]
    Morse M. Establishing a normal range for D-dimer levels through pregnancy to aid in the diagnosis of pulmonary embolism and deep vein thrombosis. J Thromb Haemost. 2004; 2(7): 1202–1204PubMedCrossRefGoogle Scholar
  19. [19]
    Francalanci I, Comeglio P, Alessandrello Liotta A, et al. D-dimer plasma levels during normal pregnancy measured by specific ELISA. Int J Clin Lab Res. 1997; 27(1): 65–67PubMedCrossRefGoogle Scholar
  20. [20]
    Ginsberg JS, Hirsh J, Rainbow AJ, Coates G. Risks to the fetus of radiologic procedures used in the diagnosis of maternal venous thromboembolic disease. Thromb Haemost. 1989; 61:189–196PubMedGoogle Scholar
  21. [21]
    Doll R, Wakefield R. Risk of childhood cancer from fetal radiation. Br J Radiol. 1997; 70:130–139PubMedGoogle Scholar
  22. [22]
    Guyatt, G, Gutterman, D, Baumann, MH, et al. Grading strength of recommendations and quality of evidence in clinical guidelines: report from an American College of Physicians Task Force. Chest 2006; 129: 174–181PubMedCrossRefGoogle Scholar
  23. [23]
    Hall JG, Pauli RM, Wilson KM. Maternal and fetal sequelae of anticoagulants during pregnancy. Am J Med. 1980; 68: 122–140PubMedCrossRefGoogle Scholar
  24. [24]
    Kearon C, Kahn SR, Agnelli G, Goldhaber S, Raskob GE, Comerota AJ. Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133:6 suppl: 454S–545SPubMedCrossRefGoogle Scholar

Copyright information

© Versita Warsaw and Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Camelia C. Diaconu
    • 1
  • Alice Bălăceanu
    • 2
  • Daniela Bartoş
    • 1
  1. 1.Internal Medicine ClinicUniversity of Medicine and Pharmacy Carol Davila, Clinical Emergency Hospital of BucharestBucharestRomania
  2. 2.Internal Medicine ClinicUniversity of Medicine and Pharmacy Carol Davila, Clinical Emergency Hospital Sf. IoanBucharestRomania

Personalised recommendations