Women undergoing a C-section (cesarean delivery) should have inflatable compression devices fitted to reduce the risk of blood clots, a leading cause of maternal mortality in the USA, says the American College of Obstetricians and Gynecologists (ACOG). The new recommendation, issued today, also includes updated guidance on the treatment, management and prevention of thromboembolism (blood clots) during pregnancy.
Thromboembolism, also known as a blood clot has the potential to obstruct blood flow, leading to damaged organs. Most blood clots in pregnant mothers are VTE (venous thromboembolism), which tend to occur within the deep veins in the leg.
Andra H. James, MD, who helped develop the guidelines, said:
“Cesarean delivery is an independent risk factor for thromboembolic events – it nearly doubles a woman’s risk.”
A blood clot which develops in the leg will cause pain and swelling. Clots can become dislodged and make their way to the lungs, causing a pulmonary embolism, a potentially fatal condition. Pulmonary embolism symptoms include coughing, chest pain and shortness of breath.
Dr. James said:
“Fitting inflatable compression devices on a woman’s legs before cesarean delivery is a safe, potentially cost-effective preventive intervention. 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 authors stress that in an emergency C-section, the procedure should not be delayed so that the compression device can be fitted.
During pregnancy a woman is four times as likely to develop thromboembolism. When a woman is pregnant her blood clots more easily, her blood flow is slower, there is compression of the pelvic and other veins, all factors which raise the risk of thromboembolism. Smoking, high blood pressure, smoking (hypertension) and obesity also raise the risk of thromboembolism.
Dr. James said:
“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.”
The recommendations explain how to treat acute or suspected cases of VTE, how to address some risk factors, and how to monitor women.
Dr. James said:
“It’s important for ob-gyns to adopt these recommendations to help reduce maternal deaths.”
Women who have had an acute VTE during pregnancy, already have a history of thrombosis, and others with a significant VTE risk, such as those with inherited or acquired thrombophilias, are advised to have anticoagulant medications, according to the recommendation.
ACOG adds that those with a history of thrombosis need to be evaluated for underlying causes before deciding whether anticoagulant drugs are suitable during pregnancy. The majority of women who are prescribed anticoagulants before they become pregnant will usually have to carry on taking them during and after their pregnancy.
Dr. James noted:
“Because half of VTE-related maternal deaths occur during pregnancy and the rest during the postpartum period, ongoing patient assessment is imperative. 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.”
Written by Christian Nordqvist