Women with apl should be considered for post partum

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Women with aPL should be considered for post-partum thromboprophylaxis ( 1B ). Recurrent Pregnancy loss D: Prophylactic Unfractionated Heparin 5000 10000 SC OR D: Low Molecula Weight Heparin (Enoxaparin) 30 40mg SC daily OR D: Dalteparin 2500 5000u SC daily starting in first trimester Patients with Thrombosis such as stroke or pulmonary embolism need therapeutic anticoagulation. D: Unfractionated Heparin (SC) 5,000 bolus and subsequent 15,000 20,000 doses at 12 hourly interval 137 Standard Treatment Guidelines 137
OR D: Low Molecular Weight Heparin (Enoxaparin) SC 1mg/kg 12 hourly Note : The aPTT needs to be checked and is best done midway between the 12 hourly doses, once every 24 hours. A target of 1.5 2.5 times the control should be aimed Referral Refer immediate to a level where monitoring of the treatment through lab testing is available. 11.5.5 Deep Vein Thrombosis in Pregnancy It is one of the major causes of maternal deaths Diagnostic Criteria Pain Swelling or redness of the calf or thigh Homan’s sign (pain in the calf in response to dorsiflexion of the foot) Investigations Venous ultrasound Venography Pharmacological Treatment D: Unfractionated heparin (UFH) is the treatment of choice 5 Loading dose 100U/kg (or minimum of 5000 U) followed by initial infusion 15-25 U/kg/hour (or minimum of 1000U/hour) Note : Check PTT every 4 hours and PTT should be maintained at 1.5 2.5 X control. Once steady state has been achieved measure PTT levels daily. Change heparin to SC route after 5 10 days Referral Immediate referral to a hospital where monitoring of the treatment through lab testing is available is recommended 11.5.6 Pulmonary Embolism in Pregnancy It is blockage, usually a blood clot, prevents oxygen from reaching the tissues of the lungs; it can be life-threatening Diagnostic Criteria Acute onset of shortness of breath (dyspnea) Pleuritic chest pain Cough and/or hemoptysis Low grade fever Tachypnea 138 Standard Treatment Guidelines
Diminished oxygen saturation Diminished breath sounds Investigations Venous ultrasound Pulmonary angiography Pharmacological Treatment D: Unfractionated heparin (UFH) is the treatment of choice Loading dose 150 U/kg (or minimum of 5000 U) followed by Initial infusion 15 25 U/kg/hour (or minimum of 1000U/hourly) Note: Check PTT every 4 hours and adjust infusion to maintained PTT at 1.5 2.5 X control. Once steady state has been achieved measure PTT levels daily. Change heparin to SC route after 5 10 days to avoid formation of hematoma. Referral Immediate referral to a health facility where monitoring of the treatment through lab tests is available is recommended 11.5.7 Vomiting in Pregnancy and Hperemesis Gravidarum It is severe nausea and vomiting in early pregnancy requiring hospital admission and rehydration.

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