Pregnancy is a hypercoagulable state: consider need for thromboprophylaxis pre-pregnancy, at booking, throughout the antenatal period, at start of labour and once delivered. See below. For caesarean section
Thromboprophylaxis after vaginal delivery:
In all pregnant women avoid immobility and dehydration.
Risk factors: (Thrombophilia/past thromboembolism considered separately). Women with any two of the risk factors opposite (RED BOX):
Treatment: Treat with low molecular weight heparin (LMWH) eg enoxaparin starting as soon as possible after delivery (as long as no postpartum haemorrhage and ≥4h after epidural catheter siting or removal—6h if that was traumatic). Continue for 3–5 days even if at home. Dose of enoxaparin: if the early pregnancy weight (EPW) is 50–90kg, give 40mg/24h SC; if EPW <50kg, give 20mg/24h SC; if EPW >90kg give 40mg/12h SC. If heparin is contraindicated, use TED compression stockings (TED = transverse elastic graduated). For women with ≥3 persisting risk factors consider antenatal and postnatal prophylaxis, starting as early in pregnancy as possible as risk throughout. Continue normal dose prophylaxis when admitted in labour.
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