Thromboprophylaxis During Pregnancy, Labour and After Vaginal Delivery

All women should undergo a documented assessment of risk factors for VTE in early pregnancy or prepregnancy. Risk assessment should be repeated if the woman is admitted to hospital for any reason or develops other intercurrent problems. Risk assessment should be repeated again intrapartum or immediately postpartum.Any woman with four or more current risk factors ,(other than previous VTE or thrombophilia) ,should be considered for prophylactic low-molecular-weight heparin (LMWH) throughout the antenatal period and will usually require prophylactic LMWH for 6 weeks postnatally but a postnatal risk reassessment should be made. Any woman with three current risk factors , (other than previous VTE or thrombophilia) should be considered for prophylactic LMWH from 28 weeks and will usually require prophylactic LMWH for 6 weeks postnatally but a postnatal risk reassessment should be made. Any woman with two current risk factors , (other than previous VTE or thrombophilia) should be considered for prophylactic LMWH for at least 10 days postpartum.Women admitted to hospital when pregnant (including to the gynaecology ward with hyperemesis gravidarum or ovarian hyperstimulation syndrome) should usually be offered thromboprophylaxis with LMWH unless there is a specific contraindication such as risk of labour or active bleeding.Women with previous VTE should be offered prepregnancy counselling and a prospective management plan for thromboprophylaxis in pregnancy made. Those who become pregnant before receiving such counselling should be referred at the earliest opportunity in pregnancy to a clinician with expertise in thrombosis in pregnancy.