Thromboembolism in Pregnancy
Publication Date: July 1, 2018
Last Updated: March 14, 2022
Recommendations
When signs or symptoms suggest new onset DVT, the recommended initial diagnostic test is compression ultrasonography of the proximal veins. (A)
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In general, the preferred anticoagulants in pregnancy are heparin compounds. (B)
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Because of its greater reliability and ease of administration, low-molecular-weight heparin is recommended rather than unfractionated heparin for prevention and treatment of VTE within and outside of pregnancy. (B)
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A reasonable approach to minimize postpartum bleeding complications is resumption of anticoagulation therapy no sooner than 4–6 hours after vaginal delivery or 6–12 hours after cesarean delivery. (B)
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Because warfarin, low-molecular-weight heparin, and unfractionated heparin do not accumulate in breast milk and do not induce an anticoagulant effect in the infant, these anticoagulants are compatible with breastfeeding. (B)
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Women with a history of thrombosis who have not had a complete evaluation of possible underlying etiologies should be tested for antiphospholipid antibodies and for inherited thrombophilias. (C)
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Adjusted-dose (therapeutic) anticoagulation is recommended for women with acute thromboembolism during the current pregnancy or those at high risk of thrombosis, such as women with a history of recurrent thrombosis or mechanical heart valves. (C)
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When reinstitution of anticoagulation therapy is planned postpartum, pneumatic compression devices should be left in place until the patient is ambulatory and until anticoagulation therapy is restarted. (C)
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Every unit should have a protocol for when pregnant women and postpartum women should have anticoagulant medications held and when women who are receiving thromboprophylaxis are eligible for neuraxial anesthesia. (C)
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Women receiving anticoagulation therapy may be converted from low-molecular-weight heparin to the shorter half-life unfractionated heparin in anticipation of delivery, depending upon the institution’s protocol. (C)
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For women who are receiving prophylactic lowmolecular-weight heparin, discontinuation is recommended at least 12 hours before scheduled induction of labor or cesarean delivery; a 24-hour interval is recommended for patients on an adjusted-dose regimen. (C)
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Placement of pneumatic compression devices before cesarean delivery is recommended for all women, and early mobilization is advised after cesarean delivery. (C)
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Each facility should carefully consider the risk assessment protocols available and adopt and implement one of them in a systematic way to reduce the incidence of VTE in pregnancy and the postpartum period. (C)
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Recommendation Grading
Overview
Title
Thromboembolism in Pregnancy
Authoring Organization
American College of Obstetricians and Gynecologists
Publication Month/Year
July 1, 2018
Last Updated Month/Year
April 1, 2024
Document Type
Consensus
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Adolescent, Adult
Health Care Settings
Ambulatory
Intended Users
Physician, nurse midwife, nurse, nurse practitioner, physician assistant
Scope
Diagnosis, Prevention, Management
Diseases/Conditions (MeSH)
D011247 - Pregnancy, D011250 - Pregnancy Complications, Hematologic, D013923 - Thromboembolism, D011248 - Pregnancy Complications
Keywords
thromboembolism, pregnancy, VTE in pregnancy