Practice Bulletin No. 123: Thromboembolism in Pregnancy

Obstet Gynecol. 2011 Sep;118(3):718-29. doi: 10.1097/AOG.0b013e3182310c4c.

Abstract

Pregnant women have a fourfold to fivefold increased risk of thromboembolism compared with nonpregnant women (1, 2). Approximately 80% of thromboembolic events in pregnancy are venous (3), with a prevalence of 0.5–2.0 per 1,000 pregnant women (4–9). Venous thromboembolism, including pulmonary embolism, accounts for 1.1 deaths per 100,000 deliveries (3), or 9 % of all maternal deaths in the United States (10). In the developing world, the leading cause of maternal death is hemorrhage (11); however, in developed nations, where hemorrhage is more often successfully treated and prevented, thromboembolic disease is one of the leading causes of death (12). The prevalence and severity of this condition during pregnancy and the peripartum period warrant special consideration of management and therapy. Such therapy includes the treatment of acute thrombotic events and prophylaxis for those at increased risk of thrombotic events. The purpose of this document is to provide information regarding the risk factors, diagnosis, management, and prevention of thromboembolism, particularly venous thromboembolism in pregnancy.

Publication types

  • Practice Guideline

MeSH terms

  • Anticoagulants / administration & dosage
  • Blood Coagulation / physiology
  • Contraceptives, Oral
  • Contraindications
  • Drug Hypersensitivity
  • Drug Monitoring
  • Female
  • Heparin / administration & dosage
  • Heparin / immunology
  • Heparin, Low-Molecular-Weight / administration & dosage
  • Humans
  • Patient Selection
  • Postpartum Period
  • Pregnancy
  • Pregnancy Complications, Cardiovascular / diagnosis
  • Pregnancy Complications, Cardiovascular / epidemiology
  • Pregnancy Complications, Cardiovascular / prevention & control
  • Pregnancy Complications, Cardiovascular / therapy*
  • Pulmonary Embolism / diagnosis
  • Pulmonary Embolism / epidemiology
  • Pulmonary Embolism / therapy
  • Risk Factors
  • Thromboembolism / diagnosis
  • Thromboembolism / epidemiology
  • Thromboembolism / prevention & control
  • Thromboembolism / therapy*
  • Venous Thrombosis / diagnosis
  • Venous Thrombosis / epidemiology
  • Venous Thrombosis / therapy
  • Warfarin / administration & dosage

Substances

  • Anticoagulants
  • Contraceptives, Oral
  • Heparin, Low-Molecular-Weight
  • Warfarin
  • Heparin