Photo by Nina Matthews
The Royal College of Obstetricians and Gynaecologists (RCOG) has released new guidelines for treating and preventing venous thromboembolism (VTE) during pregnancy, birth, and following delivery.
“These updated guidelines provide new evidence about risk factors for thrombosis in pregnancy and strategies that should be employed to reduce the chances of a thrombosis occurring,” said Andrew Thomson, MD, cochair of the RCOG guidelines committee.
“Furthermore, the guidelines provide updated information on the way women with a suspected thrombosis should be investigated and treated.”
VTE is uncommon in pregnancy or in the first 6 weeks postnatally, and the absolute risk of VTE is around 1 in 1000 pregnancies. It can occur at any stage in pregnancy, but the time of the highest risk is the first 6 weeks following birth, when the risk increases 20-fold.
Risk factors include previous VTE or thrombophilia, obesity, increased maternal age, immobility and long-distance travel, admission to hospital during pregnancy, and other comorbidities such as heart disease, inflammatory bowel disease, and pre-eclampsia.
Additional risk factors occurring during the first trimester of pregnancy include hyperemesis gravidarum, ovarian hyperstimulation, and in vitro fertilization pregnancy. Caesarean section is also a risk factor.
The guidelines emphasize that all women should undergo a thorough assessment for VTE in early pregnancy or prepregnancy and again intrapartum or immediately postpartum.
Any woman with risk factors should be considered for prophylactic low-molecular-weight heparin. The duration of treatment depends on the number of risk factors a woman has. It may be offered both antenatally and after the baby is born.
In addition, women with previous VTE must be offered prepregnancy counseling. A prospective management plan for VTE should also be made, including appropriate treatment to be offered as early as possible and a careful history documented.
The guidance on treating VTE focuses on the acute management of the condition and highlights the signs and symptoms, including leg pain and swelling, lower abdominal pain, shortness of breath, chest pain, coughing blood, and collapse.
Any woman presenting with signs and symptoms suggestive of VTE should be tested for the condition immediately and offered treatment with low-molecular-weight heparin.
All hospitals should have a protocol for the diagnosis of suspected VTE, with the involvement of a multidisciplinary team of obstetricians, radiologists, physicians, and hematologists.
“This guidance provides clinicians with accurate, scientific-based guidelines on the risk factors for VTE, as well as on how to prevent and treat the condition,” said guideline author Catherine Nelson-Piercy, MBBS, of Guy’s and St. Thomas’ NHS Foundation Trust in London, UK.
“It is vital that VTE is discussed with all women who are at risk, and the reasons for individual treatment recommendations must also be explained.”
