Thromboembolism in Pregnancy: Pathophysiological Insights, Diagnostic Challenges and Management Strategies in Low-Resource Settings

Abstract

One of the main causes of avoidable maternal fatalities worldwide, thromboembolism during pregnancy continues to be a significant contribution to morbidity and mortality. Pregnancy-related physiological changes, such as endothelial activation, venous stasis, and hypercoagulability, are intended to prevent hemorrhage after delivery. These same alterations, however, put expectant mothers at risk for venous thromboembolism (VTE), which includes pulmonary  embolism (PE) and deep vein thrombosis (DVT). Due to diagnostic difficulties, inconsistent reporting, and inappropriate classification maternal mortality, the true burden of VTE in low- and middle-income countries (LMICs), particularly in sub-Saharan Africa, is underrecognized, despite the fact that its prevalence is believed to be 1-2 per 1000 pregnancies in high-income countries. With a focus on situations with limited resources, this review summarizes the most recent findings about the pathophysiology, clinical implications, diagnostic difficulties, and therapeutic approaches of pregnancy-associated thromboembolism. In addition to new immunothrombotic and genetic pathways, we critically analyze the traditional framework of Virchow's triad, emphasizing the roles of thrombophilia, neutrophil extracellular traps, and systemic inflammation. Missed or delayed diagnoses are explored in relation to diagnostic difficulties in LMICs, such as limited availability to CT pulmonary angiography, Doppler ultrasonography, and standardized coagulation assays. In light of the restricted capability for laboratory monitoring, treatment strategies that focus on postpartum warfarin and low molecular weight heparin (LMWH) are examined. The possibility of cutting-edge technologies including artificial intelligence (AI)-driven risk stratification, mobile health platforms, and solar-powered point-of-care coagulometers to revolutionize maternal VTE care is investigated. Creating genetic biobanks, longitudinal registries tailored to African contexts, and pregnancy-specific risk prediction tools are among the top research goals. In the end, reducing thromboembolic morbidity and mortality during pregnancy requires collaborative interdisciplinary efforts, tailored laboratory innovations, and enhanced maternal monitoring systems.