Pathophysiology

• Pregnancy is a hypercoagulable state (Virchow's triad) - predisposes to thromboembolism

Dural venous sinus thrombosis

• Occlusion of the dural venous sinuses in the cranial cavity

Clinical features

• One of the differentials of headache in pregnancy
  • 70-88% present with headache but could present with seizure or other neurological sequlae

Investigations

• MR venogram

Management

• Anticoagulation - LMWH

Pulmonary artery thromboemolism

• Acute obstruction of blood flow into the lungs → secondary cardiac failure

Investigations

• CTPA or V/Q

Management

• A therapeutic, fixed dose of LMWH based on early pregnancy body weight is the recomended therapy for PE in the majority of pregnant women without haemodynamic instability
• Thrombolysis or surgical embolectomy should be considered for pregnant women with high-risk PE
• Post-natal anticoagulation with warfarin - commence on 5th post-natal day, should be continued for at least 6 weeks post-natal
• Neither heparin nor warfarin are contraindications to breast feeding

Prophylaxis in the anti-natal period