Venous thromboembolism in pregnancy and the puerperium
Risk scoring and thromboprophylaxis (SOMANZ table adapted from RCOG), previous VTE and thrombophilia, diagnosing DVT and PE in pregnancy (SOMANZ 2021 versus pregnancy-adapted YEARS), weight-based LMWH, planning birth around anticoagulation and neuraxial anaesthesia, and postpartum care.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- VTE is the commonest direct cause of maternal death in Australia (AIHW, 2014 to 2023), and a leading direct cause in UK confidential enquiries. Pregnancy raises risk about 4 to 5 times; the first 6 weeks postpartum raise it about 20 times.
- Every woman needs a documented VTE risk assessment before or early in pregnancy, on any admission, with intercurrent illness and immediately after birth.
- DVT in pregnancy is left-sided in about 85% and often proximal or iliac.
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Sources
- The SOMANZ position statement on pulmonary embolism in pregnancy and post-partumAU/NZSociety of Obstetric Medicine of Australia and New Zealand (Lowe SA, Barrett HL, Cutts BA et al.), 2021
- Maternal deaths in AustraliaAU/NZAustralian Institute of Health and Welfare, Latest release, deaths 2014 to 2023 (thromboembolism the leading direct cause)
- VTE risk assessment table (adapted from RCOG Green-top guideline 37a)AU/NZSociety of Obstetric Medicine of Australia and New Zealand, Current SOMANZ resource (uploaded 2024)
- Recommendations for the prevention of pregnancy-associated venous thromboembolismAU/NZMcLintock C et al. for SOMANZ, Aust N Z J Obstet Gynaecol 2012;52:3-13, 2012
- Therapeutic Guidelines: Cardiovascular (venous thromboembolism in pregnancy)AU/NZTherapeutic Guidelines Ltd
- Reducing the risk of venous thromboembolism during pregnancy and the puerperium (Green-top guideline 37a)Royal College of Obstetricians and Gynaecologists, 2015 (still current; no replacement found November 2026)
- American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancyBates SM et al., Blood Adv 2018;2:3317-59, 2018
- Pregnancy-adapted YEARS algorithm for diagnosis of suspected pulmonary embolism (Artemis)van der Pol LM et al., N Engl J Med 2019;380:1139-49, 2019
- Diagnosis of pulmonary embolism during pregnancy: a multicenter prospective management outcome study (CT-PE-Pregnancy)Righini M et al., Ann Intern Med 2018;169:766-73, 2018
- Intermediate-dose versus low-dose low-molecular-weight heparin in pregnant and post-partum women with a history of venous thromboembolism (Highlow)Bistervels IM et al., Lancet 2022;400:1777-87, 2022
- Last updated
- 14 November 2026
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