Deep Venous Thrombosis

Swollen

Step 1: View clinicals

A 32 year old lady in her first pregnancy presents at 31 weeks of gestation with pain and swelling of her left leg for one day. She also complains of feeling feverish. There is no history of trauma. She was diagnosed with gestational diabetes mellitus at 27 weeks, which is well controlled via dietary measures. Her medical and surgical histories are unremarkable.


Step 2: Order all relevant investigations

Full blood count

WBC/DC: 10,000/mm3 N: 70% L: 25% Hb: 12.1 g/dl Plt: 350,000/mm3

D-Dimer assay

The D-Dimer assay is positive

Doppler scan Left/LL

The popliteal and femoral veins show filling defects and are non compressible. Flow augmentation to respiration is absent.

X-Ray Knee Joint

The x-ray appears normal


Step 3: Select appropriate management

Enoxaparin stat
IV Thrombolytics stat
Warfarin stat
Urgent cesarean section


Score: ★★☆