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Abstract

Thromboembolism prophylaxis during pregnancy and after birth

Venous thromboembolism (VTE) is one of the leading causes of direct maternal death in industrialized countries. Its incidence is 1 to 2/1000 births, the absolute risk of VTErelated maternal deaths between 0.8 to 4.7/100,000 pregnancies.

The cornerstones of its prevention are the individual and careful assessment of preexisting and new-onset risk factors during pregnancy as well as after birth and a riskstratified thromboembolism prophylaxis preferably with low-molecular weight heparins (LMWH). A check list of the most important risk factors for VTE as well as clinical interventions for physical and medical VTE prophylaxis based on current guidelines should be readily available in each obstetric unit. For clinical purpose the Scoring System of the RCOG Guideline No. 37a (2015) is an appropriate tool for individual risk stratification and recommendations from this and other international guidelines are presented in this article.

LMWH is the method of choice for pharmacological prophylaxis of thromboembolism because e.g. of its low rate of side effects and high patient?s compliance, however, the off-label use of LMWH in pregnancy and associated problems (e.g. assumption of costs) should be taken into consideration. Because of decreasing hospitalisation prescription modalities after patient?s discharge and occasionally consecutive puerperal supply gaps remain unsolved problems.

CME Prakt Fortbild Gynakol Geburtsmed Gynakol Endokrinol 2017; 13(1): 38–52

Keywords
Venous thromboembolism, pregnancy, puerperium, risk assessment/stratification, mechanical and pharmacological prophylaxis

Werner Rath
Medizinische Fakultät Universitätsklinikum Schleswig-Holstein,
Campus Kiel
Reviewer: Rupert Bauersachs, Darmstadt,
und Ulrike Friebe-Hoffmann, Ulm

Rath W. Thromboseprophylaxe ... Gynakol Geburtsmed Gynakol Endokrinol 2017; 13(1): 38–52 publiziert 31.03.2017 www.akademos.de/gyn ©akademos Wissenschaftsverlag 2017 ISSN 1614-8533