Professional Documents
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Policy Reference 25
Maternity
Thromboprophylaxis in pregnancy, following vaginal delivery
and caesarean section
Thromboprophylaxis in
pregnancy, following vaginal
delivery and caesarean section
Policy Details:
Author job title:
Dept/Working Group(s):
Ratifying Body:
Date ratified:
Date operational:
Date to be reviewed:
PFI involvement: project
liaison completed
accordingly (Yes/No)
Refers to the following Trust
policies:
Review History:
First Operational:
Previously
Reviewed:
Updated yes/no:
October 2003
January
April
2007
2007
Yes
Yes
Postnatal
0.304 per 1000
0.720 per 1000
Thrombophilic abnormalities affect 15% of the population. Risk factors may act
synergistically. 1
Monitoring is required for therapeutic doses and a twice daily dosing regime
should be considered in view of the altered pharmacokinetics in pregnancy.
Skin rashes are occasionally seen with LMWHs and are seen more commonly
in pregnancy.
Monitoring of LMWH
It can only be done by using an anti-X assay as the APTT is not affected by
LMWH
Anti-Xa levels should be checked every 4 weeks during the 1st and 2nd
trimesters and every 2 weeks in the 3rd trimester and LMWH doses altered
accordingly.
Operational Date: 11/07/07
Review Date: April 2010
Treatment
6 weeks postnatal prophylactic dose LMWH or warfarin (INR target 2.5)
Consider antenatal LMWH if strong +ve family history of VTE
Length of treatment:
Moderate and high risk - continue until day 5 or fully mobile whichever is
later (i.e. the minimum length of treatment is 5 days)
Women in the high risk group only should be discharged with TED
stockings, unless otherwise instructed by medical staff
Low risk
Moderate risk
Those women who are at low risk (non or one of the above risk factors)
require early mobilisation and avoidance of dehydration only
Women with two current risk factors (to include pre-existing and new
onset/transient factors) should be considered for and offered heparin
prophylaxis for five days post-partum