The American College of Obstetricians and Gynecologists (ACOG) has released a bulletin, which recommends that all women undergoing cesarean delivery should undergo thromboembolism prophylaxis at the time of delivery. A thromboembolism is a blood clot, which travels to the lungs and can cause death. According to the Los Angeles County Department of Public Health, 19% of all maternal mortalities in the county are due to a thromboembolism. The new bulletin, entitled “Thromboembolism in Pregnancy,” was published in the September 2011 issue of Obstetrics & Gynecology; its focus was to summarize evidence and recommendations regarding risk factors, diagnosis, management, and prevention of thromboembolism, especially venous thromboembolism (VTE), in pregnancy. A VTE most often occurs within the deep veins of the left leg. “Cesarean delivery is an independent risk factor for thromboembolic events—it nearly doubles a woman’s risk,” said Andra James, MD, who helped develop the guidelines. Most women who develop clots in the legs will experience pain or swelling in that area. Sometimes, clots break off and travel to the lungs where they can cause a life-threatening condition known as pulmonary embolism. Symptoms include sudden shortness of breath, chest pain, and coughing.
“Fitting inflatable compression devices on a woman’s legs before cesarean delivery is a safe, potentially cost-effective preventive intervention,” said Dr. 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.” The College notes, however, that an emergency cesarean delivery should not be delayed for the placement of compression devices.
Pregnancy is associated with a 400% increase in the risk of thromboembolism. Clotting problems are more common among pregnant women because of the physiological changes that accompany pregnancy, such as blood that clots more easily, slower blood flow, compression of pelvic and other veins, and decreased mobility. Other risk factors include a personal history of VTE, an increased tendency for excessive clotting (thrombophilia), and medical factors such as obesity, hypertension, and smoking. Dr. James noted, “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.”
Cesarean birth rate on the rise in the U.S.
Vaginal birth after cesarean––are you a candidate?
New study on antidepressants taken during pregnancy
Alarming new report: Pregnancy-related strokes on the increase
Quitting smoking when newly pregnant has same benefits as never smoking
ACOG receives funds to aid California women during pregnancy