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PREGNANCY AND PUERPERIAL VTE CHECKLIST (KKM 2017) *


Tick
VTE
VTE risk factors Pre-pregnancy/ Admission/ Post
score
Booking New Illness delivery
Date
Pre-existing risk factors
Previous VTE 4
High risk thrombophilia 3
Medical comorbidities 3
(malignancies, cardiac failure, active
SLE, IVDU/TB, nephrotic syndrome,
DM with nephropathy, thalassemia
major or intermedia post
splenectomy)
BMI ≥ 40kg/m2 2
BMI 30-39 kg/m2 1
Family history of VTE 1
Low risk thrombophilia 1
Current smoker (≥10 per day) 1
Obstetric risk factors
Caesarean section (emergency & 2
elective)
Pre-eclampsia 1
Mid-cavity rotation instrumental 1
delivery
Prolonged labour (> 24hours) 1
Postpartum haemorrhage 1
(> 1000mls or requiring blood
transfusion
Stillbirth(current) 1
IVF (first trimester only) 1
Transient risk factors*
Surgical procedures 4
(except episiotomy repair, repair of
1st and 2nd degree perineal tear,
evacuation of products of conception)
Hyperemesis gravidarum/OHSS 4
Admission beyond 3 days 1
Systemic infection/infection requiring 1
IV antibiotics
Long distance travel (> 4 hours) 1
Immobility/ dehydration 1
Note: Thromboprophylaxis is recommended during the transient period. Consider stopping once the
transient risks are deemed no longer significant.

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