Thromboembolic disorders in obstetrics

Thromboembolic disorders remain a leading cause of maternal mortality in the developed world. The halving of the number of deaths from thromboembolic disorders in the last Confidential Enquiry provides further proof that they are largely preventable. A formal assessment of risk factors (e.g. previous thromboembolic disorders, thrombophilia, obesity) should be made at booking and at the time of delivery, or when intercurrent problems develop or the woman is admitted. Women with risk factors pre-dating pregnancy should be offered pre-pregnancy counselling and planning. Thromboprophylaxis should be instituted as soon as practical, bearing in mind that potentially fatal thromboembolic disorders may occur in the first trimester. All women presenting in pregnancy with new chest symptoms should be thoroughly investigated. Imaging is safe and should not be withheld. Treatment should be started empirically while the investigations are completed. Both prophylaxis and treatment doses should be carefully adjusted to take into account the weight of the woman.