Venous thromboembolism during pregnancy

The incidence of venous thromboembolism (VTE) in pregnancy is increased approximately 4 to 50 times compared to nonpregnant women, due to the changes that pregnancy itself produces in the coagulation and fibrinolytic systems. It is estimated that VTE complicates between 1 and 1.5 per 1,000 pregnancies. During pregnancy maternal hemostasis is characterized by a prothrombotic state in which changes are produced in the hemostatic system in order to prevent possible bleeding during early pregnancy, childbirth and postpartum. Moreover, the maternal hemostatic system adaptation to pregnancy predisposes the mother to an increased risk of VTE. The diagnosis of thromboembolic events in pregnancy is a challenge for the Maternal fetal specialists as clinical and laboratory findings that are a characteristic of this disease, may be masked on own physiological changes of pregnancy, making the startup of the evaluation often complex. For the proper and timely diagnosis of DVT and PE, a combination of several elements is required, including: symptoms and signs, laboratory and imaging studies. The use of anticoagulants in obstetric patients requires a controlled plan for the moment of labor and delivery. In everyday clinical practice, this is not always possible due to the inability to predict the time of onset of labor. For this reason, the recommendations relating to the analgesic and anesthetic management of labor are based on knowledge of the physiological, pharmacokinetic and pharmacodynamics changes of anticoagulant used, which is discussed at length in this review.