A 33-year-old multiparous woman is reviewed by the senior house officer in the postnatal
ward. She had a Caesarean section for failure to progress and has been using an epidural for
pain relief for the last 4 hours following Caesarean section. The midwife has just given her the
first dose of prophylactic LMWH postnatally.

You are called urgently to see a collapsed woman in room 4 on the labour ward. She has
just had a prolonged labour and instrumental delivery. The midwife says the woman complained
of slight headache, became short of breath and then said she had chest pain before she
collapsed.
Which of these symptoms is not suggestive of a pulmonary embolism?

What is the incidence of post-thrombotic syndrome (PTS) following a deep venous
thrombosis (DVT) in pregnancy?

A 31-year-old woman presents at 34 weeks’ gestation with a dull ache in her left calf. She is
a smoker, and on examination there are superficial varicose veins present on both sides with
localised left calf tenderness. Doppler studies show a loss of patency of the left long saphenous
vein with a thrombus extending for 5 cm along the left popliteal fossa.

A 31-year-old woman presents at 34 weeks’ gestation with a twin pregnancy with pain in her
right calf. She is a smoker and her body mass index is 34 at booking. On examination she has
bilateral varicose veins and right-sided superficial thrombophlebitis. Doppler studies report
normal patency of the deep venous system of both legs. She has a family history of
antithrombin III deficiency.

A 38-year-old multiparous woman is admitted to the antenatal ward for an elective
Caesarean section for breech presentation. She had a pulmonary embolism during this
pregnancy and has been on a therapeutic dose of LMWH (90 mg twice daily) for the last 3
months. She took her last dose just before coming into the ward.

A 31-year-old woman presents at 34 weeks’ gestation with severe pain in both calves. The
pain generally worsens over the day. On examination there are marked varicosities involving
the long saphenous territory. Duplex examination shows bilateral saphenofemoral reflux.
Doppler studies confirm normal patency of the deep venous system of both legs.

A fit, 39-year-old, 18-week pregnant woman presented with non-specific abdominal pain,
left-sided leg pain and oedema to the emergency department following a recent safari holiday in
Africa. Doppler ultrasound scan of the leg is normal.
What is the most likely diagnosis?

A43-year-old multiparous woman presents to the EPAU at 12weeks' gestation with mild
vaginal bleeding. She gives a history of unprovoked deep venous thrombosis (DVT) 1year prior
to this pregnancy and was treated with warfarin for 6 months. Currently, the GP has started her
on aspirin in view of a previous history of pre- eclampsia

A 24-year-old woman in her second pregnancy presents at 12 weeks’ gestation with
confirmed venous thromboembolism (VTE). How would you advise her with regard to her
treatment?

A 25-year-old woman who is 28 weeks pregnant is being treated for a confirmed deep vein
thrombosis and weighs 95 kg. This is her second deep vein thrombosis in the last five years.
The haematologist requests an investigation on this patient.

A woman with a BMI of 37 kg/m2 and asthma had an elective Caesarean section for
breech at term with blood loss of 1300 ml. She was discharged home three days later. One
week later, she became acutely short of breath and collapsed. What is the most likely
diagnosis?

A 30-year-old woman who delivered 8 hours ago gives a history of previous thrombophilia.
Her mode of delivery was Caesarean section for a prolonged second stage of labour. She had a
massive postpartum haemorrhage and her current haemoglobin level is 80 gL. The midwife
comes to you to inform you about the minimal soakage of the Caesarean section wound
dressing.

A40-year-old multiparous woman presents to the obstetric day assessment unit at 28
weeks' gestation with reduced fetal movements [normal cardiotocograph (CTG)}.Her notes
indicate that she had DVT at 20weeks' gestation during her current pregnancy and is on 80 mg
LMWH twice daily. Her booking blood results were normal. However, her recent blood test
reveals a platelet count of 60 x 109/L.

A 38-year-old gravida 3 Para 2 is admitted at 32 week gestation feeling unwell. She has
been gradually becoming more anxious through the day with cough and chest pain, which was
worse during inspiration. Observations are as follows:

Temperature 37.2 ∘C,
Pulse 110 per minute,
BP 98/60,
RR 24 per minute and blood gases reveal mild respiratory alkalosis.
What is the most appropriate management plan?

. A 33-year-old multiparous woman has been taking therapeutic low molecular weight
heparin (LMWH) from 34 weeks gestation for confirmed pulmonary embolism. She has an
uncomplicated spontaneous normal vaginal delivery at 38 weeks gestation.

16) What is the most appropriate postnatal management?