Saving Mothers' Lives: - Public Health Agency for Northern Ireland

2 Thrombosis and thromboembolism
James Drife
Thromboembolism: Specifi c recommendations
There is an urgent need for a guideline on the management of obese pregnant women with a BMI over 35.
Public information and education messages are necessary so that women at risk of problems in
pregnancy because of their weight, family history or past history can seek advice before pregnancy.
Health professionals must be aware that women are at risk of thromboembolism from the very
beginning of pregnancy. Guidelines for the management of women at risk of thromboembolism are
contained in the Annex to this Chapter.
At booking, a full risk and needs assessment must be undertaken before maternity care plans are
decided. Because of their co-morbidity, obese women with a BMI of 35 or more are unsuitable for
midwife-only care.
Telephone consultations require particular care because early symptoms of life-threatening embolism
are generally mild and reassurance is too easy to give and accept.
Thromboprophylaxis should be a routine part of the management of ovarian hyperstimulation syndrome.
Summary of key fi ndings for 2003-05
The deaths of 41 women who died from thrombosis and/or thromboembolism are counted in this Chapter.
Of these, 33 deaths were attributed to pulmonary embolism and eight to cerebral vein thrombosis.
Additionally, three Late deaths attributed to pulmonary embolism are counted in Chapter 15 but the lessons
to be learnt from these cases are discussed here.
Pulmonary embolism still remains the leading Direct cause of maternal death in the United Kingdom with
a mortality rate of 1.56 per 100,000 maternities. Although the numbers of deaths attributed to pulmonary
embolism appear to be higher than the 25 cases identifi ed in the previous Report for 2000-2002, the
difference is not statistically signifi cant as Table 2.1 shows.
Table 2.1
Direct deaths from thrombosis and thromboembolism and rates per 100,000 maternities; United Kingdom:
1985-2005.
Pulmonary embolism Cerebral vein thrombosis Thrombosis and
thromboembolism
Number Rate 95 per cent CI Number Rate 95 per cent CI Number Rate 95 per cent CI
1985-87 30 1.32 0.83 1.89 2 0.09 0.02 0.32 32 1.41 1.00 1.99
1988-90 24 1.02 0.68 1.51 9 0.38 0.20 0.72 33 1.40 1.00 1.96
1991-93 30 1.30 0.91 1.85 5 0.22 0.09 0.51 35 1.51 1.09 2.10
1994-96 46 2.09 1.57 2.79 2 0.09 0.02 0.33 48 2.18 1.65 2.90
1997-99 31 1.46 1.03 2.07 4 0.19 0.07 0.48 35 1.65 1.19 2.29
2000-02 25 1.25 0.85 1.85 5 0.25 0.11 0.59 30 1.50 1.05 2.14
2003-05 33 1.56 1.11 2.19 8 0.38 0.19 0.75 41 1.94 1.43 2.63
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