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APPENDIX VPostnatal assessment and management (to be assessed on delivery suite)                          Obstetric thromb...
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Postnatal thromboprophylaxis RCOG Recommendations

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Postnatal thromboprophylaxis

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Postnatal thromboprophylaxis RCOG Recommendations

  1. 1. APPENDIX VPostnatal assessment and management (to be assessed on delivery suite) Obstetric thromboprophylaxis risk assessment and management Any previous VTE+ High risk Anyone requiring antenatal LMWH At least 6 weeks postnatal prophylactic LMWH Caesarean section in labour Asymptomatic thrombophilia (inherited or acquired) Intermediate risk BMI > 40 kg/m 2 At least 7 days postnatal prophylatic LMWH Prolonged hospital admission MEDICAL COMORBIDITIES, e.g. heart or lung disease, SLE, cancer, Note: if persisting or > 3 risk factors, consider imflammatory conditions, nephrotic extending thromboprophylaxis with LMWH syndrome, sickle cell disease, intravenous drug user Age > 35 years Obesity (BMI > 30kg/m2) Parity ≥ 3 2 or more risk factors Smoker Elective caesarian section Any surgical procedure in the puerperium Gross varicose veins < 2 risk factors Current systemic infection Immobility, e.g. paraplegia, SPD, long distance travel Pre-eclampsia Mid-cavity rotational operative delivery Lower risk Prolonged labour (> 24 hours) Mobilisation and avoidance of dehydration PPH > 1 litre or blood transfusionKeyART = assisted reproductive therapy, BMI = body mass index (based on booking weight), gross varicose veins = symptomatic,above the knee or associated with phlebitis/oedema/skin changes, immobility = ≥ 3 days, LMWH = low-molecular-weightheparin, OHSS = ovarian hyperstimulation syndrome, PPH = postpartum haemorrhage, SLE = systemic lupus erythematosus,SPD = symphysis pubis dysfunction with reduced mobility, thrombophilia = inherited or acquired, long-distance travel = > 4hours, VTE = venous thromboembolismRCOG Green-top Guideline No. 37 33 of 35 © Royal College of Obstetricians and Gynaecologists

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