This document provides guidelines for postnatal assessment and management of obstetric thromboprophylaxis risk. It identifies three levels of risk - high, intermediate, and lower. Women at high risk, such as those with a previous VTE, require at least 6 weeks of postnatal prophylactic low molecular weight heparin (LMWH). Those at intermediate risk, including those with caesarean sections or thrombophilia, require a minimum of 7 days of LMWH. Women at lower risk should be advised on mobilization and hydration. Risk factors are identified for each category.

1. APPENDIX V
Postnatal 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 transfusion
Key
ART = 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-weight
heparin, 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 = > 4
hours, VTE = venous thromboembolism
RCOG Green-top Guideline No. 37 33 of 35 © Royal College of Obstetricians and Gynaecologists