++
Thromboembolic disease is a major contributor to both perinatal and maternal morbidity and mortality worldwide, accounting for 14.9% of maternal deaths in 2006, according to the World Health Organization (WHO).1 In developed countries, thromboembolism has risen above hemorrhage and hypertension as the leading cause of maternal mortality.2 Venous thromboembolic diseases (VTE)—such as deep venous thrombosis (DVT), pulmonary embolism (PE), septic pelvic thrombophlebitis (SPT), and ovarian vein thrombosis (OVT)—complicate 0.76 to 1.72 per 1000 pregnancies.3 The cornerstones of VTE management lie in prevention, accurate diagnosis, and prompt treatment. This chapter will review the etiology, diagnosis, treatment, and prevention of VTE.
+++
REGULATION OF HEMOSTASIS
++
A detailed discussion of the clotting system, the anticoagulant system, and the fibrinolytic system is beyond the scope of this manual and can be found elsewhere in more comprehensive textbooks. A practical and user-friendly version of the complex regulatory pathways of hemostasis and fibrinolysis is presented in Fig. 7-1.
++
++
As a result of physiologic changes in pregnancy, VTE occurs at a rate that is 4-fold higher compared to the nonpregnant state....