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- Source: Campus Sanofi
RCOG Guidance on Reducing Venous Thromboembolism Risk in Pregnancy
This article summarizes Royal College of Obstetricians and Gynaecologists guidance on reducing venous thromboembolism risk during pregnancy and the puerperium, a period associated with physiologically elevated thrombosis risk. The guidance outlines a structured approach to risk assessment and thromboprophylaxis recommendations across the antenatal and postpartum periods. Healthcare professionals can use this summary to support consistent application of these recommendations in obstetric practice.
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APL = antiphospholipid antibodies (lupus anticoagulant, anticardiolipin antibodies, β2-glycoprotein 1 antibodies); ART = assisted reproductive technology; BMI based on booking weight; DM = diabetes mellitus; FHx = family history; gross varicose veins = symptomatic, above knee or associated with phlebitis/oedema/skin changes; high-risk thrombophilia = antithrombin deficiency, protein C or S deficiency, compound or homozygous for low-risk thrombophilias; IBD = inflammatory bowel disease; immobility = ≥ 3 days; IVDU = intravenous drug user; IVF = in vitro fertilisation; LMWH = low-molecular-weight heparin; long-distance travel = > 4 hours; low-risk thrombophilia = heterozygous for factor V Leiden or prothrombin G20210A mutations; OHSS = ovarian hyperstimulation syndrome; PGP = pelvic girdle pain with reduced mobility; PPH = postpartum haemorrhage; thrombophilia = inherited or acquired; VTE = venous thromboembolism.
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Antenatal and postnatal prophylactic dose of LMWH
- Weight < 50 kg = 20 mg enoxaparin/2500 units dalteparin/3500 units tinzaparin daily
- Weight 50–90 kg = 40 mg enoxaparin/5000 units dalteparin/4500 units tinzaparin daily Weight 91–130 kg = 60 mg enoxaparin/7500 units dalteparin/7000 units tinzaparin daily
- Weight 131–170 kg = 80 mg enoxaparin/10000 units dalteparin/9000 units tinzaparin daily
- Weight > 170 kg = 0.6 mg/kg/day enoxaparin/ 75 u/kg/day dalteparin/ 75 u/kg/day tinzaparin
You can access the full guidelines here:
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Pregnancy induces physiological changes including increased clotting factor activity, reduced venous flow due to uterine compression, and reduced mobility in later stages, all of which raise venous thromboembolism risk relative to the non-pregnant state. This elevated risk persists into the postpartum period and gradually returns to baseline over subsequent weeks. These physiological changes underpin the rationale for structured, pregnancy-specific risk assessment guidance.
RCOG guidance recommends risk assessment at the initial booking visit, again if the patient is admitted to hospital for any reason during pregnancy, and once more following delivery. This repeated assessment approach accounts for the way risk factors can change throughout pregnancy and the postpartum period. Each assessment point may lead to a different thromboprophylaxis recommendation based on the risk factors present at that time.
Higher-risk patients are typically offered pharmacologic thromboprophylaxis, most commonly with low molecular weight heparin, alongside general measures such as maintaining mobility and adequate hydration. The specific duration and timing relative to delivery are individualized based on the patient's risk category and any planned interventions such as cesarean delivery. Healthcare professionals should coordinate timing of prophylaxis carefully around labor and delivery to balance thrombosis prevention with bleeding risk.
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