References

Abdul Sultan A, West J, Tata LJ Risk of first venous thromboembolism in pregnant women in hospital: Population-based cohort study from England. BMJ. 2013; 347 https://doi.org/10.1136/bmj.f6099

De Sancho MTI, Khalid S, Christos PJ Outcomes in women receiving low-molecular weight heparin during pregnancy. Blood Coagul Fibrinolysis. 2012; 23:(8)751-5 https://doi.org/10.1097/MBC.0b013e328358e92c

Heit JA, Kobbervig CE, James AH Trends in the incidence of venous thromboembolism during pregnancy or postpartum: A 30-year population-based study. Ann Intern Med. 2005; 143:(10)697-706

Henriksson P, Westerlund E, Wallén H Incidence of pulmonary and venous thromboembolism in pregnancies after in vitro fertilisation: Cross sectional study. BMJ. 2013; 346 https://doi.org/10.1136/bmj.e8632

Khalifeh A, Grantham J, Byrne J Tinzaparin safety and efficacy in pregnancy. Ir J Med Sci. 2014; 183:(2)249-52 https://doi.org/10.1007/s11845-013-0998-7

MBRRACE-UK. Saving Lives, Improving Mothers' Care—Lessons learned to inform future maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009–12. 2014. http://tinyurl.com/nfqejhk (accessed 12 August 2015)

National Institute for Health and Care Excellence. Venous thromboembolism: Reducing the risk. CG92. 2012. http://www.nice.org.uk/guidance/cg92 (accessed 12 August 2015)

Parent F, Deruelle P, Sanchez O Safety of therapeutic doses of tinzaparin during pregnancy. Gynecol Obstet Invest. 2015; 79:(4)256-62 https://doi.org/10.1159/000367846

Royal College of Obstetricians and Gynaecologists. Reducing the risk of venous thromboembolism during pregnancy and the puerperium. Green-top guideline No. 37a. 2015. http://www.rcog.org.uk/globalassets/documents/guidelines/gtg-37a.pdf (accessed 12 August 2015)

Sultan AA, West J, Tata LJ Risk of first venous thromboembolism in and around pregnancy: A population-based cohort study. Br J Haematol. 2012; 156:(3)366-73 https://doi.org/10.1111/j.1365-2141.2011.08956.x

Risk of venous thromboembolism during pregnancy and birth

02 September 2015
8 min read
Volume 23 · Issue 9

Abstract

Death from venous thromboembolism (VTE) in pregnancy is potentially preventable. Guidelines from the Royal College of Obstetricians and Gynaecologists (2015) provide a framework to assist clinicians in risk-stratifying pregnant women and offer measures to reduce the possibility of developing VTE. The biggest challenge for clinicians is to remember to risk-stratify women while not over-medicalising a ‘normal’ pregnancy.

Venous thromboembolism (VTE) is the leading cause of direct maternal deaths in the UK (Royal College of Obstetricians and Gynaecologists (RCOG), 2015). A report published by MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK) found that 30 out of 252 maternal deaths between 2009 and 2011 were attributed to VTE: 1.26 per 100 000 maternities (Knight et al, 2014). This mortality rate is more than double that attributed to haemorrhage, and almost three times that of pre-eclampsia and eclampsia.

This finding is not new. Confidential enquiry historical data prior to 2006 demonstrate that VTE has been the main direct cause of maternal deaths since 1985. In 2006–2008, VTE dropped to third place in the list of the most common causes of maternal death (0.79 per 100 000), behind genital sepsis, pre-eclampsia and eclampsia. Although there is no significant statistical difference between the change in the mortality rate of VTE over time, there have been improvements in the survival rates for other causes of maternal death, therefore VTE has returned as the leading direct cause of death in pregnant women. These figures, however, do not account for the large number of women who survive a VTE episode but go on to have a morbidity later in life.

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • Unlimited access to the latest news, blogs and video content

  • Monthly email newsletter