Thrombosis and Embolism during Pregnancy and the Puerperium, Reducing the Risk (Green-top 37a)

This is the second edition of this guideline, which was published in 2004 under the title Thromboprophylaxis During Pregnancy, Labour and after Vaginal Delivery.

The aim of this guideline is to provide advice, based on clinical evidence where available, regarding the prevention of VTE during pregnancy, birth and following delivery. Of note, the National Institute for Health and Clinical Excellence (NICE) guideline on venous thromboembolism (due November 2009) includes pregnancy and the puerperium as risk factors and the present guideline aims to be consistent with the clinical practice recommendations included in the NICE guideline.

This guideline reviews the risk factors for VTE in pregnancy and the puerperium and provides guidance as to which women require thromboprophylaxis in and after pregnancy. It reviews the safety and efficacy of different forms of thromboprophylaxis. For the diagnosis and management of acute VTE in pregnancy please refer to Green-top guideline No. 37b. This guideline covers thromboprophylaxis after caesarean section andthus it replaces the previously published Report of the RCOG Working Party on Prophylaxis AgainstThromboembolism in Gynaecology and Obstetrics from 1995. This guideline excludes the management of pregnancy loss and other pregnancy complications, even in women with documented thrombophilia. For anticoagulation for mechanical heart valves in pregnancy, the reader is directed to the chapter covering this problem within the proceedings of the RCOG study group on Heart Disease and Pregnancy. A summary ofthe guideline for antenatal and postnatal thromboprophylaxis is given in Figure 1 and the 23 recommendations are listed in the executive summary at the start of this document. As is apparent from the low grading of the evidence for many of the recommendations, they have been developed to provide a broad practical guide for obstetricians in clinical practice. However, it is recognised that,in individual women, alternative approaches may be reasonable, particularly following discussion with the woman concerned and, where available, input from a local expert in the field of thrombosis in pregnancy.

This guideline will be available to download as a pdf below.

Reducing the Risk of Thrombosis and Embolism during Pregnancy and the Puerperium (Green-top 37a)

Please note that this Guideline was previously number 37.

Date published: 18/11/2009

main menu