medical notes

Apr 17th, 2015
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DVT INPREGNANCY-Med4LecturesDr John OngechMBChB,MMed(Obs-Gynae)UONPublic Health,Tulane,USAScope of the lectureDefinitionEpidemiologyPathophysiologyDiagnosisManagementDefinition/EpidemiologyDVT-Deep venous thrombosis-blood clotformed in the veins0.5-3/1000 pregnanciesLeading cause of maternal mortality in the westCommon in the left more than RightCommon in post operative period esp. C/S (riskis x9SVD)PathophysiologyVirchows triad-Stasis, Coagulation and injuryPregnancy- a) increase coagulation factors1,2,7,8,9,10 b) Stasis due to Progesterone andmechanical( decrease venous return)Other risk factors-Trauma, infection, obesity,contraceptive pills especially containing estrogenDiagnosisClinical presentation- pain, swelling, tenderness, rednessMeasurements- Difference in leg circumference >2cmusing a reference point-ie 10cm from tibial tuberosityor 20cm from anterior superior iliac spineHomans sign-nolonger used-dorsiflex ,causes pain butmay dislodge clot causing pulmonary embolismInvestigations; i)Doppler U/S most important toconfirm DVT, ii)Venography-invasive expensive,radiological exposure iii) Impendance plethysmographyIv) Other Inv. D-dimer tests,Fibrinopeptides, Bthromboglobulin-non-specific tests used in researchManagementHistory- a) Predisposing factors-trauma, contraceptives,infections, immobility,surgery, c/s tumors

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