{"id":3688,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/adviceonpregnantorpre-pregnancyinindividualwithpersonalorfhofthrombosis\/"},"modified":"2023-08-31T14:35:16","modified_gmt":"2023-08-31T13:35:16","slug":"pregnancypreconceptionfhthrombosis","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/haematology\/haematology-pregnancy-preconception\/pregnancypreconceptionfhthrombosis\/","title":{"rendered":"Pregnancy\/Preconception\/FH thrombosis"},"content":{"rendered":"\n<title>Advice on Pregnant or pre-pregnancy in individual with personal or FH of thrombosis<\/title>\n\n\n\n<h4 class=\"wp-block-heading\">Pregnancy or preconception with personal or family history of thrombosis<\/h4>\n\n\n\n<p>The referral pathway depends on whether the patient is pregnant:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Preconception: patients should be referred to Department of Haematology at RIE or SJH<\/li>\n\n\n\n<li>Pregnant: mostly via the locality consultant obstetrician to the Combined Haematology Obstetric clinic at the Simpson Centre for Reproductive Health RIE or Combined Haematology Obstetric clinic at SJH<\/li>\n<\/ul>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who to refer:<\/h4>\n\n\n\n<p><strong>Pregnant<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>URGENT REFERRAL \u2013 for any patient already taking warfarin, VKA, DOAC, LMWH or fondaparinux. Please see relevant <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/pregnancyorpreconceptionadvicewarfarinordoacs\/\">RefHelp guidance for pregnant women on warfarin or DOACs<\/a>. <strong><em>Patients on oral anticoagulants must be referred urgently.<\/em><\/strong><\/li>\n\n\n\n<li>HIGH PRIORITY REFERRAL (as early in pregnancy as possible) any of the following:\n<ul class=\"wp-block-list\">\n<li>previous personal history of VTE<\/li>\n\n\n\n<li>patient with known high-risk thrombophilia: antithrombin deficiency, protein C deficiency, protein S deficiency, combined defects, homozygotes for FV Leiden and PT20210A<\/li>\n\n\n\n<li>patient with any known thrombophilia and significant additional risk factors<\/li>\n\n\n\n<li>patient with antiphospholipid syndrome.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>LESS URGENT:\n<ul class=\"wp-block-list\">\n<li>patient with lower risk thrombophilia, no personal history of thrombosis<\/li>\n\n\n\n<li>patient with first degree relative with proven venous thrombosis below age of 45yrs, unprovoked, or provoked by COCP or pregnancy or minor risk factor or associated with known thrombophilia.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Patient with personal history of arterial thrombosis:<ul><li>refer to consultant obstetrician<\/li><\/ul>\n<ul class=\"wp-block-list\">\n<li>except rare cases where there is a history of &nbsp;antiphospholipid syndrome, or other rare blood disorder, who should be referred to haematology.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p><strong><u>Planning Pregnancy<\/u><\/strong><\/p>\n\n\n\n<p>All referrals should be routine:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Any women meeting criteria for very urgent or high priority referral in pregnancy should be referred for pre-pregnancy counselling. For patients on long-term anticoagulation, please seek initial advice from the clinician already managing the patient&nbsp; for the underlying condition. Pre-pregnancy counselling by a haematologist and obstetrician is also recommended.<\/li>\n\n\n\n<li>Pre-pregnancy counselling\/referral pre-pregnancy should be considered for lower risk patients as above. Decision to refer depends on details of the personal and family history.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Patient with unproven VTE or episode where VTE was excluded.<\/li>\n\n\n\n<li>Patient with family history of arterial thrombosis including thrombotic \/ embolic stroke<\/li>\n\n\n\n<li>Patient with family history of VTE in relative &gt; 45 years of age or with major provoking factor (eg surgery, cancer) or unproven history of VTE.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<p>Preconception: refer via SCI Gateway to Haematology at RIE or SJH.<\/p>\n\n\n\n<p>Pregnancy: Make the referral according to priority categories above by SCI Gateway or letter, copying in locality obstetric consultant.<\/p>\n\n\n\n<p>For pregnant patients on anticoagulation, see relevant <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/pregnancyorpreconceptionadvicewarfarinordoacs\/\">RefHelp guidance (warfarin \/ DOACS<\/a>) &#8211; these patients should be referred urgently.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h3 class=\"wp-block-heading\">\u200bPrimary care investigations<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Clinical history and documentation of results of imaging \/ diagnosis are most important.<\/li>\n\n\n\n<li>For most patients, sending a thrombophilia screen from primary care is not helpful.<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>RCOG Guideline on Prevention of VTE in Pregnancy: <a href=\"https:\/\/www.rcog.org.uk\/globalassets\/documents\/guidelines\/gtg-37a.pdf\">gtg-37a.pdf (rcog.org.uk)<\/a><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Advice on Pregnant or pre-pregnancy in individual with personal or FH of thrombosis Pregnancy or preconception with personal or family history of thrombosis The referral pathway depends on whether the patient is pregnant:<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":15929,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[252],"class_list":["post-3688","page","type-page","status-publish","hentry","category-pregnancyinindividualwithpersonalorfhofthrombosis"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/haematology\/coagulopathy\/pregnancyinindividualwithpersonalorfhofthrombosis\/\" rel=\"tag\">Advice on Pregnant or Pre-Pregnancy in Individual with Personal or FH of Thrombosis<\/a>","rttpg_excerpt":"Advice on Pregnant or pre-pregnancy in individual with personal or FH of thrombosis Pregnancy or preconception with personal or family history of thrombosis The referral pathway depends on whether the patient is pregnant:","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3688","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=3688"}],"version-history":[{"count":8,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3688\/revisions"}],"predecessor-version":[{"id":16281,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3688\/revisions\/16281"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/15929"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=3688"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=3688"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}