Pulmonary Embolism (PE) & Deep Vein Thrombosis (DVT) — Pregnancy & Postpartum
THE INFORMATION IN THE OBPHARMTM IS INTENDED SOLELY FOR USE BY THE MEDICAL PROFESSION. IT IS NOT INTENDED FOR LAY PERSONS.
FOCUS INFORMATION TECHNOLOGY, INC. DOES NOT ASSUME ANY RESPONSIBILITY FOR ANY ASPECT OF HEALTHCARE ADMINISTERED WITH THE AID OF THIS CONTENT. THE PRESCRIBING PHYSICIAN MUST BE FAMILIAR WITH THE FULL PRODUCT LABELING AS PROVIDED BY THE MANUFACTURER AND RELEVANT MEDICAL LITERATURE PRIOR TO USING THE OBPHARM.
This orderset and calculators are educational and do not replace institutional protocols, hematology/cardiology/anesthesia consultation, or current guidelines.
1) Initial Stabilization & Diagnostic Workup
- Assess ABCs, maternal hemodynamics, and fetal status.
- Continuous pulse oximetry, cardiac and blood pressure monitoring.
- Consider ICU/step-down for hypotension, RV strain, or high-risk PE features.
- Diagnostic imaging per institutional protocol (e.g., CTPA vs. V/Q, compression ultrasound for DVT).
- Baseline labs: CBC, CMP, PT/INR, aPTT, fibrinogen, troponin/BNP (if PE suspected), blood type and screen.
2) Risk Stratification & Consultation
- Stratify as massive, submassive, or low-risk PE based on hypotension, RV dysfunction, and biomarkers.
- Early consultation: Maternal-Fetal Medicine, Cardiology, Pulmonology, Hematology, Anesthesiology, Critical Care as indicated.
- Discuss timing of delivery if gestational age viable and maternal condition unstable.
3) Anticoagulation Orders & Integrated Calculators
3A. Weight- and Creatinine-Adjusted Anticoagulation Dosing
Use for initial therapeutic/prophylactic dosing. All dosing must be individualized to current guidelines and institutional protocols.
Standard Anticoagulation Framework (for reference)
- Therapeutic LMWH (typical starting point): Enoxaparin 1 mg/kg SQ q12h (or 1.5 mg/kg q24h in selected patients).
- Prophylactic LMWH: ~40 mg SQ q24h or ~0.5 mg/kg q24h (adjust by BMI and institutional protocol).
- IV UFH (for high-risk or near delivery): 80 U/kg bolus, then 18 U/kg/hr infusion with aPTT-guided titration.
- Consider transition from LMWH to IV UFH as planned delivery or neuraxial anesthesia approaches.
3B. Delivery Countdown — Planning Around Anticoagulation
Helps visualize time to planned delivery relative to holding LMWH/UFH and anesthesia planning.
3C. Neuraxial Anesthesia Safety Checker (Educational)
Estimates whether typical time thresholds since last anticoagulant dose are met for neuraxial anesthesia, based on commonly cited SOAP/ASRA-style intervals. Not a substitute for formal anesthesia evaluation.
4) Postpartum Management & Duration of Therapy
- Typical total duration for pregnancy-associated VTE is at least 3 months and through a minimum of 6 weeks postpartum (confirm with current guidelines).
- Postpartum transition options may include warfarin or DOACs if not breastfeeding and no contraindications (institution- and guideline-dependent).
- Reassess thrombophilia workup, future pregnancy prophylaxis, and contraception choices.