Non-injection alternatives for DVT

During pregnancy, unfortunately, there are no alternatives to heparin/LMWH injections.

The other form of anticoagulation treatment, apart from heparin, is warfarin. Warfarin is administered orally.

There is consensus now that warfarin is not safe to use in pregnancy. There are quite a few abnormalities that have been associated with warfarin use during pregnancy. It is also known that this may happen at whatever stage of pregnancy the treatment is used.

Abnormalities associated with warfarin use in pregnancy include abnormal shape of the face, small head (microcephaly), blindness or a missing spleen.

Even though all of these complications are uncommon, they are serious enough to make the use of warfarin in pregnancy not worthwhile, particularly when an effective alternative is available.

Pulmonary embolism (PE) in Pregnancy

Pulmonary embolism essentially means a blood-clot lodging in a blood vessel within the lungs. The lung section that is affected will then have its blood circulation cut off. The symptoms that the individual will experience will depend on the actual site of the blockage and the size of lung section affected.

Symptoms may range from non-specific ones including a

v cough,

v localized chest pain,

v mild fever or

v Coughing up thin blood-stained sputum.

When there is a major embolism, there could be sudden severe crashing chest pain, shortness of breath and even passing out.

Investigating suspected pulmonary embolism

When a pregnant woman or a newly delivered woman has clinical symptoms suggestive of pulmonary embolism, it is dealt with as an emergency.

If there is strong suspicion, treatment will start even before confirmatory tests are done.

This is because pulmonary embolism is a truly serious complication, which could easily and quickly lead to a fatal outcome.

Of course, if tests establish a different diagnosis, treatment can be stopped. Investigations carried out include blood analysis to check gas levels (including oxygen and carbon dioxide), chest X-ray and ECG.

Using a V/Q scan or a CT Pulmonary angiogram (CTPA) in pregnancy

All these tests are non-specific and the diagnosis may still remain elusive. If this is the case, then a more specialized test called a V/Q scan (also called a ventilation perfusion scan) is performed. This is very sensitive and, even though it is not foolproof, if a pulmonary embolism is ruled out by a V/Q scan, there is almost certainly no danger to the patient. An alternative test to the V/Q scan is what is known as a CT Pulmonary angiogram or CTPA. It is also a very sensitive test but, like with V/Q, ionising radiation is involved and therefore, it is used cautiously during pregnancy.

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