In August, The American College of Obstetricians and Gynecologists (ACOG) issued new guidelines to reduce the rates of maternal mortality from blood clots in pregnant women undergoing cesarean delivery. In the US, blood clots are a leading cause of maternal death.
The majority of blood clots in pregnant women are caused by venous thromboembolism (VTE) in deep veins of the leg. According to ACOG, pregnant women are at a fourfold increased risk for thromboembolism when compared with nonpregnant women. The reasons for the increased risk during pregnancy include slower blood flow, compression of pelvic veins and decreased mobility. Other risk factors for VTE in pregnant women include having prior VTEs, smoking, high blood pressure and obesity.
The guidelines include recommendations that all women scheduled for cesarean section should undergo thromboembolism prophylaxis (preventive treatment) at delivery to prevent clots. These recommendations were published in Practice Bulletin #123, “Thromboembolism in Pregnancy,” in the September 2011 issue of Obstetrics & Gynecology.
“VTE is a major contributor to maternal mortality in this country,” said Andra H. James, MD, coauthor of the ACOG guidelines. She is a physician with the Obstetrics and Gynecology/Maternal and Fetal Division at Duke University Medical Center in Durham, North Carolina. “The risk of VTE is increased during pregnancy and the consequences can be severe. The recommendations explain how to monitor women for these events, address certain risk factors, and treat suspected or acute cases of VTE. It’s important for ob-gyns to adopt these recommendations to help reduce maternal deaths.” James is a member of the National Hemophilia Foundation’s Medical and Scientific Advisory Council.
The recommendations include the use of compression ultrasonography (imaging of deep structures of the body by measuring ultrasonic waves) to diagnose DVTs; anticoagulant medications, such as heparin, warfarin and low molecular weight heparin; and pneumatic compression devices (PCDs).
PCDs are inflatable garments, powered by an electric pneumatic pump, that inflate and deflate at certain intervals to help prevent thrombosis. “Fitting inflatable compression devices on a woman’s legs before cesarean delivery is a safe, potentially cost-effective preventive intervention,” said James. “Inflatable compression sleeves should be left in place until a woman is able to walk after delivery or — in women who had been on blood thinners during pregnancy — until anticoagulation medication is resumed.” One key component of the new recommendations is ensuring that anticoagulant therapies are continued postpartum, if needed--a time when clots can still occur.
Sources: Medscape Medical News, August 26, 2011; ACOG news release, August 26, 2011