title: Obstetrical venous thromboembolism: Epidemiology and strategies for prophylaxis.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY. Electronic address: Alexander.Friedman@gmail.com.
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Friedman
authors.affiliation: Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
authors.forename: Cande V
authors.initials: CV
authors.lastname: Ananth
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D002585:Cesarean Section; D005260:Female; D014943:Global Health; D006801:Humans; D011181:Postnatal Care / Q000379:methods* / Q000592:standards; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology* / Q000517:prevention & control*; D011295:Prenatal Care / Q000379:methods* / Q000592:standards; D018570:Risk Assessment; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants
keywords: Thromboembolism; care quality; maternal mortality; severe morbidity