Initial evaluation of DVT in pregnancy and postpartum: Traditional approach

This figure summarizes one approach to diagnosing DVT during pregnancy and postpartum. In this traditional approach, all patients suspected of having DVT undergo initial evaluation with CUS. An alternative approach that uses D-dimer level and clinical suspicion is presented separately. There is no one optimal approach and choosing between them depends on clinician preference, resource availability, clinical suspicion, and patient preference. This algorithm is intended for use in conjunction with additional UpToDate content.

CUS: compression ultrasound; DVT: deep vein thrombosis.

* Whole-leg (rather than proximal vein) CUS is preferred in pregnancy and postpartum due to its ability to detect calf vein DVT. However, the choice between these options may be institution-dependent. The clinician should know which type is performed by the bedside technician. In advanced pregnancy, CUS should be performed with the patient in the left lateral decubitus position.

¶ Once DVT is diagnosed, anticoagulation is indicated. Refer to UpToDate content on treatment of DVT in pregnant and postpartum patients.

Δ D-dimer level may also be obtained. In most patients, empiric anticoagulation is not needed.

◊ The iliac vein is not well visualized on proximal vein or whole-leg CUS. Magnetic resonance venography is an alternative if Doppler is inconclusive. Empiric therapy should be administered in this population while waiting for testing.

§ This decision should be individualized. Alternative imaging modalities include magnetic resonance imaging. Notably, the suspicion for calf vein DVT should be very low if whole-leg CUS was performed as the initial test.

Graphic 90286 Version 4.0

خرید پکیج

Initial evaluation of DVT in pregnancy and postpartum: Traditional approach