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RCOG Risk assessment
for Venous Thromboembolism
| 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
MAT-EG-2500019
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