Venous Thromboembolism & Obstetric Anaesthesia

Abstract

Pregnancy related VTE and PE is a common cause of preventable maternal morbidity and mortality
Most women who develop pregnancy related VTE/PE have identifiable risk factors
Early risk assessment in pregnancy is recommended, with re-assessment performed should any change in condition occur, particularly any condition requiring hospitalization
In addition to non-pharmacological methods, LMWH is safe and recommended for pharmacological prophylaxis
With prophylactic LMWH there should be a minimum 12 hour period prior to neuraxial blockade, with the next dose being at least 2 hours after insertion or removal of a neuraxial block
Prophylactic LMWH should commence between 4-8 hours post delivery, provided there is a 24 hour window between doses
All women who receive a neuraxial block in conjunction with pharmacological VTE prophylaxis should be educated and monitored for evidence of a neuraxial haematoma
Women at intermediate risk of VTE/PE should have 7 days of LMWH therapy whilst those at high risk should be treated for 6 weeks