Current research data and guidelines on reducing maternal thromboembolism risk have been incorporated into a consensus safety bundle from the National Partnership for Maternal Safety, published online September 5 in Obstetrics & Gynecology. However, some specialists express concern that the consensus statement relies too heavily on pharmacologic prophylaxis without sufficient evidence to justify the approach.

According to Mary E. D'Alton, MD, from the Columbia University College of Physicians and Surgeons, New York City, and colleagues, "the thromboembolism bundle is not a new guideline but rather represents a selection of existing guidelines and recommendations in a form that aids implementation and consistency of practice that is appropriate for the individual birthing facility."

Venous thromboembolism (VTE) during pregnancy is a leading cause of maternal morbidity and mortality, with pulmonary thromboembolism accounting for an estimated 9.3% of pregnancy-related deaths in the United States.

Although maternal death from VTE is preventable by implementing comprehensive thromboembolism prevention strategies, prophylaxis guideline recommendations from medical and surgical specialties can differ substantially. In addition, clinical trial data remain lacking for the guidance of thromboprophylaxis in pregnancy.

In the United Kingdom, guidelines from the Royal College of Obstetricians and Gynaecologists (RCOG) recommend broad, risk-based assessments for antepartum and postpartum women to guide thromboprophylaxis. As a result, many women receive pharmacologic thromboprophylaxis, including, for example, most women who undergo cesarean delivery. Indeed, data have shown a significant reduction in maternal deaths from VTE in the United Kingdom since release of the RCOG guidelines.

Currently, in the United States, however, only women at highest risk for VTE receive pharmacologic thromboprophylaxis. Data have also shown an increased rate of obstetric VTE in the United States in recent decades, with no change in its associated rate of maternal deaths.

On the basis of these findings, the National Partnership for Maternal Safety therefore critically reviewed current guidelines and research evidence and made recommendations for prophylaxis. The safety bundle contains recommendations within four major areas.

Readiness, Recognition, Response, Reporting and Systems Learning

Readiness: The authors recommend that all pregnant women undergo risk assessment for VTE throughout pregnancy. In particular, clinicians should assess patients during the first prenatal visit, during any antepartum hospitalizations, immediately postpartum during a hospitalization for childbirth, and after they are discharged home after a delivery. Clinicians should use standardized risk-assessment tools such as the Caprini and Padua scoring systems.

Recognition: On the basis of results of this risk assessment, clinicians should use a patient's modified Caprini or Padua score to identify those who are at high risk for VTE, and who are therefore candidates for thromboprophylaxis. Continue Reading