REDUCING THE RISK OF THROMBOSIS AND EMBOLISM DURING PREGNANCY AND THE PUERPERIUM

REDUCING THE RISK OF THROMBOSIS AND EMBOLISM DURING PREGNANCY AND THE PUERPERIUM
© Royal College of Obstetricians and Gynaecologists

This is the second edition of this guideline, which was published in 2004 under the title Thromboprophylaxis
During Pregnancy, Labour and after Vaginal Delivery.
Executive summary of recommendations
Recommendations for thromboprophylaxis during pregnancy

All women should undergo a documented assessment of risk factors for venous thromboembolism (VTE)(listed in Table 1, Figure 1 and Appendix III) in early pregnancy or before pregnancy. This assessment should be repeated if the woman is admitted to hospital for any reason or develops other intercurrent problems.

Women at high risk of VTE in pregnancy, such as those with previous VTE, should be offered prepregnancy counselling and a prospective management plan for thromboprophylaxis in pregnancy.

Those who become pregnant before receiving such counselling should be referred to a consultant obstetrician or trust-nominated expert in thrombosis in pregnancy early in pregnancy.

Women with a previous non-estrogen-related VTE provoked by a minor risk factor should undergo testing for thrombophilia, as this will influence management and decisions regarding thromboprophylaxis antenatally.

Antenatal thromboprophylaxis should begin as early in pregnancy as practical.

Low molecular weight heparins (LMWH) are the agents of choice for antenatal thromboprophylaxis.

These are at least as effective as and safer than unfractionated heparin.

Any woman with three or more current or persisting risk factors listed in Table 1 should be considered for prophylactic LMWH antenatally.

Women with a previouss single provoked (excluding estrogen-related) VTE and no other risk factors require close surveillance; antenatal LMWH is not routinely recommended.
Women with previous recurrent VTE or a previous unprovoked or estrogen or pregnancy-related VTE or a previous VTE and a history of VTE in a first-degree relative (or a documented thrombophilia) or other risk factors should be offered antenatal thromboprophylaxis with LMWH.© Royal College of Obstetricians and Gynaecologists

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