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Thrombosis and Embolism during Pregnancy and the Puerperium, the Acute Management of (Green-top Guideline No. 37b)

Published: 01/02/2007

Update November 2014: This guideline is currently being revised, with publication anticipated early 2015. The version available on the website and app will remain valid until replaced.

This is the second edition of this guideline, which was previously published in April 2001 under the same title. Please note: this guideline was previously Green-top Guideline No. 28.

Venous thromboembolism (VTE) remains the main direct cause of maternal death in the UK and sequential reports of Confidential Enquiries into Maternal Deaths have highlighted failures in obtaining objective diagnoses and employing adequate treatment. The subjective, clinical assessment of deep venous thrombosis (DVT) and pulmonary thromboembolism (PTE) is particularly unreliable in pregnancy and a minority of women with clinically suspected VTE have the diagnosis confirmed when objective testing is employed. However, VTE is up to ten times more common in pregnant women than in non-pregnant women of the same age and can occur at any stage of pregnancy, but the puerperium is the time of highest risk.

The aim of this guideline is to provide information, based on clinical evidence where available, regarding the immediate investigation and management of women in whom venous VTE is suspected during pregnancy or the puerperium.

Thromboprophylaxis during pregnancy, labour and after vaginal delivery is addressed in RCOG Green-top Guideline No. 37a.