New guidelines from the American College of Obstetricians and Gynecologists contain recommendations to help prevent, manage and treat blood clots in pregnant women. Blood clots are a leading cause of maternal morbidity, with pregnancy associated with a four-fold increase in the risk of thromboembolism. As such, ACOG released “Thromboembolism in Pregnancy” in the September 2011 issue of Obstetrics & Gynecology to guide clinicians in the prevention, management and treatment of blood clots during pregnancy.
C-sections, like all surgeries, increase the risk of blood clots and deep vein thrombosis (DVT). Dr Andra H James, one of the guidelines creators, explained in a press statement: “Cesarean delivery is an independent risk factor for thromboembolic events—it nearly doubles a woman’s risk.” James is an assistant professor in the department of obstetrics and gynecology at the Duke University Medical Center, co-director of Duke’s Comprehensive Hemostasis and Thrombosis Center, and founder of Duke’s Women’s Hemostasis and Thrombosis Clinic.
The guidelines recommend the use of boot-like compression devices during the procedure unless time is of the essence (eg, before an emergency operation) or the patient is taking anti-clotting medication. These devices would slip over each leg and regularly inflate and deflate to improve blood flow. Although there is limited data on the efficacy of these devices in patients undergoing c-sections, the use of these devices in other surgeries has reduced the risk of clots by two-thirds.
Since the devices are relatively inexpensive and easy to use, their use makes clinical sense, Dr Erin DuPree, deputy chief medical officer Mount Sinai Medical Center in New York, said in a statement to the press. She noted that her institution has used these devices for a few years at a cost of $14 per patient. She explained the device is usually removed and replaced some time during the first day after surgery and is no longer needed by the second day. “It’s an easy thing to do that really does not cause harm and could potentially help,” she added.
Since as many as two of every 1,000 women during pregnancy will experience a DVT, the guidelines also remind obstetricians to screen and monitor their patients for risk of DVT, including checking for history of blood clots, prior DVT, and those women with inherited clotting disorders. Such women may need anti-clotting medicines during their pregnancy. “While warning signs in some women may be evident early in pregnancy, others will develop symptoms that manifest later in pregnancy or after the baby is born,” James explained in a press statement. “Because half of VTE [venous thromboembolism]-related maternal deaths occur during pregnancy and the rest during the postpartum period, ongoing patient assessment is imperative.”
James added, “It’s important for ob-gyns to adopt these recommendations to help reduce maternal deaths… VTE is a major contributor to maternal mortality in this country. The risk of VTE is increased during pregnancy and the consequences can be severe.”
Forum discussion: Who is already following these guidelines?
ACOG Office of Communications.
New Recommendations to Prevent Blood Clots During Cesarean Deliveries Issued.
Press statement. August 22, 2011.
Associated Press. Need a C-section? Protection From Blood Clot Urged. August 30,