Pregnancy and labor management: women with venous thromboembolism or associated significant risk factors

Abstract

This paper describes diagnosis, treatment, and control of acute venous thromboembolism (VTE) and antithrombotic prophylactic management during pregnancy and puerperium, especially in women with inherited thrombophilia. VTE is currently one of the three main causes of maternal morbidity in Japan. With approximately 0.05%-0.08% incidence rate per total number of births, it is becoming increasingly comparable with other developed countries. Pregnancy is characterized by high blood clotting potential due to increased coagulation factors, decreased anticoagulant activity, and fibrinolysis. Additionally, unique obstetric risk factors exist, such as cesarean section, prolonged bed rest, obesity, preeclampsia, and dehydration due to hyperemesis. Moreover, notable risk factors for VTE in pregnancy and puerperium for patients with inherited thrombophilia (e.g., deficiencies in antithrombin, protein C, and protein S) and acquired thrombophilia (e.g., antiphospholipid antibodies, history of VTE) have been reported; this study describes inherited thrombophilia in details.