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

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Annex 2.1
Prophylaxis against thromboembolism in caesarean section
The following recommendations, taken from the RCOG Working Party Report on prophylaxis against
thromboembolism 5 , are widely used for risk assessment and are of relevance to women requiring
caesarean section. It is important to note that the 2004 guideline 3 updates and replaces previous guidance
on dosage of thromboprophylaxis.
Box 2.1.1
RCOG Risk assessment profi le for thromboembolism in caesarean section
Low risk - Early mobilisation and hydration
Elective caesarean section - uncomplicated pregnancy and no other risk factors
Moderate risk – Consider one of a variety of prophylactic measures
• Age >35 years
• Obesity (>80kg)
• Parity 4 or more
• Labour 12 hours or more
• Gross varicose veins
• Current infection
• Pre-eclampsia
• Immobility prior to surgery (>4 days)
• Major current illness, e.g. heart or lung disease, cancer, infl ammatory bowel disease,
nephrotic syndrome
• Emergency caesarean section in labour
High risk – Heparin prophylaxis +/- leg stockings
• A patient with three or more moderate risk factors from above
• Extended major pelvic or abdominal surgery, e.g. caesarean hysterectomy
• Patients with personal or family history of deep venous thrombosis, pulmonary embolism or
thrombophilia paralysis of lower limbs
• Patients with antiphospholipid antibody (cardiolipin antibody or lupus anticoagulant)
Management of different risk groups
Low risk patients
Patients undergoing elective caesarean section with uncomplicated pregnancy and no other risk factors
require only early mobilisation and attention to hydration.
Moderate risk patients
Patients assessed as of moderate risk should receive subcutaneous heparin (doses are higher during
pregnancy) or mechanical methods. Dextran 70 is not recommended until after the delivery of the fetus
and is probably best avoided in pregnant women.