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RCOG-Based Risk Assessment Tool for VTE in Pregnancy and Puerperium
This tool applies Royal College of Obstetricians and Gynaecologists risk-assessment criteria to help healthcare professionals evaluate venous thromboembolism risk during pregnancy and the postpartum period. It considers pre-existing risk factors, obstetric factors and transient risk factors that can change throughout pregnancy. Healthcare professionals can use the resulting risk category to guide decisions on antenatal or postpartum thromboprophylaxis.
| Score interpretation | Consideration |
| If total score ≥ 4 antenatally | Thromboprophylaxis from the first trimester |
| If total score 3 antenatally | Thromboprophylaxis from 28 weeks |
| If total score ≥ 2 postnatally | Thromboprophylaxis for at least 10 days |
| If admitted to hospital antenatally | Thromboprophylaxis. |
| If prolonged admission (≥ 3 days) or readmission to hospital within the puerperium | Thromboprophylaxis. |
For patients with an identified bleeding risk, the balance of risks of bleeding and thrombosis should be discussed in consultation with a hematologist with expertise in thrombosis and bleeding in pregnancy.
| High risk | Intermediate risk | Lower risk | |
| Antenatal management | Requires antenatal prophylaxis with LMWH | Consider antenatal prophylaxis with LMWH | Early mobilization and avoidance of dehydration |
| Postnatal management | At least 6 weeks postnatal prophylactic LMWH |
At least 10 days postnatal prophylactic LMWH.
|
If less than 2 points Mobilization and avoidance of dehydration. If the score is 2 it’s treated the same as intermediate risk |
| If the Total Risk Factor Score is 2, in this case patient is in low risk to develop VTE | If the Total Risk Factor Score is 3, in this case patient is in Intermediate risk to develop VTE | If the Total Risk Factor Score is 4 or more, in this case patient is in High risk to develop VTE |
| The Antenatal management Regimen is Mobilization and avoidance of dehydration | The Antenatal management Regimen is Consider antenatal prophylaxis with LMWH from 28 weeks | The Antenatal management Regimen is prophylaxis with LMWH from the first trimester Refer to trust-nominated thrombosis in pregnancy expert/team |
| The Postnatal management Regimen is Thromboprophylaxis for at least 10 days postnatal prophylactic LMWH. | The Postnatal management Regimen is At least 10 days’ postnatal prophylactic LMWH | The Postnatal management Regimen is At least 6 weeks’ postnatal prophylactic LMWH |
RCOG: Royal College of Obstetricians and Gynecologists; VTE: Venous thromboembolism; LMWH: Low-molecular-weight heparin; ART: Assisted reproductive technology; IVF: In vitro fertilization; OHSS Ovarian hyperstimulation syndrome; PPH: Postpartum hemorrhage; BMI: Body mass index.
- Royal college of obstetricians & Gynecologists (RCOG). Reducing the Risk of Venous Thromboembolism during Pregnancy and the Puerperium. Available at: https://www.rcog.org.uk/media/qejfhcaj/gtg-37a.pdf. Last accessed at: 1.10.2023
Thrombosis risk during pregnancy changes over time due to physiological changes and the emergence of new risk factors such as immobility, hospitalization or a specific delivery outcome, so a single assessment at booking is not sufficient. Reassessment at admission and again postpartum captures these evolving risk factors. This approach ensures thromboprophylaxis decisions remain appropriate as the pregnancy and postpartum period progress.
The tool considers pre-existing factors such as prior thrombosis history or thrombophilia, obstetric factors like multiple pregnancy or postpartum hemorrhage, and transient factors such as current immobility or systemic infection. Each category contributes to an overall risk stratification specific to the pregnancy or postpartum stage being assessed. This structured approach helps standardize thromboprophylaxis decisions across different clinical scenarios in obstetric care.
Postpartum thromboprophylaxis is typically recommended for women identified as intermediate or high risk based on the weighted combination of persisting and new risk factors following delivery, particularly after cesarean birth or with additional risk factors present. Duration of prophylaxis can vary depending on the specific risk factors identified. Healthcare professionals should reassess risk factors specifically at the postpartum stage rather than relying solely on the antenatal assessment.
MAT-EG-2500019
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