Obstetrical venous thromboembolism: Epidemiology and strategies for prophylaxis

Venous thromboembolism (VTE) is a leading cause of severe maternal morbidity and mortality. While pregnancy alone is a risk factor for VTE, additional population-based risk factors such as obesity are becoming increasingly common, particularly in the developed world. Maternal death from VTE is amenable to prevention and VTE thromboprophylaxis is the most readily implementable means of systematically reducing the maternal death rate. In the United States, prophylaxis is recommended primarily for patients at extremely high risk for thromboembolism and women undergoing cesarean delivery, whereas in the United Kingdom a larger proportion of the population is targeted. Given the maternal burden of obstetric VTE and varying strategies for prevention, this article will provide a review of the following topics: (1) global epidemiology of obstetric VTE, (2) prophylaxis guidelines in the United States and the United Kingdom, and (3) maternal mortality from VTE in the United States and the United Kingdom in the setting of differing prophylaxis strategies.