Viva 4

A 35-year-old woman, gravida 2, para 1, who is 30 weeks pregnant, has been admitted to your ICU with pre-eclampsia. Her blood pressure is 160/100 mmHg treated with hydralazine and  metoprolol  prior  to  her  admission.  IV  vasodilators  are  being  considered.  She  has moderate proteinuria,  normal liver function and a platelet count of 120 x 109. There is no evidence of foetal distress. Her significant past history included a Factor V Leiden mutation and a history of proximal vein thrombosis during her first pregnancy.

1.   What pharmacological regime would you recommend for DVT prophylaxis and why? The rest of the viva was a discussion  on thromboprophylaxis  in pregnancy  including  the
results of the recent PROTECT study.

Disclaimer: the viva stem above may be an original CICM stem, acquired from their publicly available past papers. Or, perhaps it is a slightly altered version of the original CICM stem. Or, it is a completely original viva stem, concocted by the monstrously amoral author of Deranged Physiology for nothing more than his own personal amusement. In either case, because the college do not make the main viva text or marking criteria available, almost everything here has been confabulated. It might sound like a plausible viva and it could be used for the purpose of practice, but all should be aware that it does not represent the "true" canonical CICM viva station.