Society for Maternal-Fetal Medicine (SMFM) Consult Series #51: Thromboembolism Prophylaxis for Cesarean Delivery.

Abstract Venous thromboembolism (VTE) is a major cause of maternal morbidity and mortality. The risk of VTE is particularly elevated during the postpartum period and especially following cesarean delivery. There is considerable variation in the approach to VTE prophylaxis in pregnancy, including following cesarean delivery. The purpose of this document is to discuss the different guidelines on VTE prophylaxis following cesarean delivery and provide recommendations based on the available evidence. The following are Society for Maternal-Fetal Medicine (SMFM) recommendations: We recommend that all women who undergo cesarean delivery receive sequential compression devices starting prior to surgery and that they be continued until the patient is fully ambulatory (GRADE 1C); we suggest that women with a previous personal history of a deep venous thrombosis or pulmonary embolism who undergo cesarean delivery receive both mechanical (starting preoperatively and continuing until ambulatory) and pharmacological (for 6 weeks postoperatively) prophylaxis (GRADE 2C); we suggest that women with a personal history of an inherited thrombophilia (high risk and low risk) but no previous thrombosis who undergo cesarean delivery receive both mechanical (starting preoperatively and continuing until ambulatory) and pharmacological (for 6 weeks postoperatively) prophylaxis (GRADE 2C); we recommend the use of low-molecular-weight heparin as the preferred thromboprophylactic agent in pregnancy and the postpartum period (GRADE 1C); when pharmacologic thromboprophylaxis is needed in women with class III obesity, we suggest the use of intermediate doses of enoxaparin (GRADE 2C); we suggest that each institution develop a patient safety bundle with an institutional protocol for venous thromboembolism prophylaxis among women who undergo cesarean delivery (Best Practice).