Risk factors
Name two major risk factors for VTE in pregnancy.
Obesity, smoking, surgery, vascular endothelial injury, IV luer
What are two common signs of DVT?
Swelling, Pain, Redness, Low-grade fever, Difficulty weight bearing
How can a midwife help prevent VTE in postpartum women?
Encourage mobility
A pregnant woman is planning a long-haul flight. What advice should the midwife provide regarding VTE prevention?
Encourage her to wear compression stockings and mobilise regularly during the flight. Inform her of signs and symptoms of a DVT/PE and advise her to seek medical advice if these occur.
Name three medical conditions that increase VTE risk?
Haemorrhoids, varicose veins, cancer, nephrotic syndrome, lupus, antiphospholipid syndrome, factor 5 leiden
How does oxygen saturation change in a PE event?
It reduces
Why is early mobilization important in preventing VTE?
Helps to reduce stasis
A 28-year-old woman, 10 days postpartum, develops chest pain after climbing stairs. What should the midwife do?
Assess for other signs and risk factors for PE, refer if needed.
Why does a C-section increase the risk of VTE?
All points of Virchow's triad present
How does a midwife assess a leg for suspected DVT when in a primary setting?
Measure the circumference of the leg 10 cm below the tibial tuberosity and compare with the asymptomatic leg. A difference of more than 3 cm between the extremities increases the probability of DVT
What is the category of referral under the referral guidelines for a woman who has had a previous DVT or PE?
Consultation (code 1040)
A woman asks why she has been prescribed heparin after birth. How should the midwife explain this?
Discuss DVT/PE - risk factors and why prophylaxis is recommended relative to the woman's personal/family/medical history.
Name four things that increase postpartum VTE risk
Caesarean section, placental abruption, postpartum infection, PPH
Why is hemoptysis (coughing up blood) a concerning symptom?
It indicates the PE is larger/more severe
What role does compression therapy play in reducing DVT risk?
Encourages blood to circulate better when the woman is unable to mobilise (counteracts stasis)
A 32-year-old pregnant woman at 34 weeks presents with unilateral leg redness and tenderness. How should the midwife respond?
Refer the woman immediately to the obstetric team for assessment (current DVT/PE is an emergency under the referral guidelines - code 4042).
How does a high BMI affect VTE risk?
All points of the Virchow's Triad are present (Stasis, Hypercoagulation, Endothelial Injury).
What is the difference between mild leg swelling and a DVT-related swelling?
DVT swelling in legs will be unilateral
What should a midwife do if a woman refuses anticoagulant treatment?
Discuss signs and symptoms of DVT/PE, who to contact and what to do if these occur, document the woman's decision.
A midwife is reviewing a postpartum woman’s medical history and notices she has Factor V Leiden. What should be done?
Encourage mobility, check if the woman has been prescribed anticoagulants (thromboprophylaxis), assess need for TEDs or SCDs, monitor for signs and symptoms of DVT/PE, ensure the woman is aware of the signs and symptoms of DVT/PE and who to inform if these occur.