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Thromboprophylaxis
1.
ุจุณู ุงููู ุงูุฑุญู ู
ุงูุฑุญูู
2.
12th Annual
Congress โRAS EL BAR โ 5- 2009 Thromboprophylaxis During Pregnancy, Birth and Puerperium Dr. Mahdy El-Mazzahy Damietta General Hospital
3.
problem solving
4.
5.
6.
7.
8.
9.
10.
Antenatal Assessment &
Management (To be assessed at booking and repeated if admitted) 1.Age > 35 yrs 2.Obesity (BMI>30kg/m2) 3.Parity > 3 4 Smoker 5.MEDICAL CO-MORBIDITIES e.g. heart or lung disease; SLE; cancer; inflammatory conditions; Proteinuria >3g/24 hrs; Sickle Cell Disease . 6.Gross varicose veins 7.Current systemic infection 8.Immobility, e.g. paraplegia, SPD, long-haul travel 9.Pre-eclampsia 10. Dehydration/hyperemesis/OHSS 11.Multiple pregnancy or ART 12.Surgical procedure e.g. ERPC 3 or more risk factors 2 or more if admitted <3 risk factors Intermediate Risk Consider antenatal prophylaxis with LMWH Low Risk Mobilisation & avoidance of dehydration. Green-top Guideline April 2009
11.
Timing of initiation
of thromboprophylaxis
12.
13.
Which agents should
be used for thromboprophylaxis?
14.
15.
16.
RCOG Guideline April
2009 Thromboprophylaxis During Pregnancy Tinzaparin 20,000U/ml Enoxaparin (100 U/mg) weight 3500 U/d 4500 U/d 7000 U/d* 9000 u/d* 75u/kg/d* 4500U/12 h 175U/kg/12h (antenatal &postnatal) 20 mg/d 40 mg/d 60 mg/d* 80mg/d* 0.5mg/kg/d* 40 mg/12h 1mg/kg/12h (antenatal) 1.5 mg post Body weight < 50 kg Normal weight : 50โ90 kg Body weight 91-130 kg Body weight 131-170 kg >170 kg Higher prophylactic dose(50-90kg) Treatment dose
17.
Thromboprophylaxis after delivery
18.
19.
Postnatal Assessment &
Management (to be assessed on Delivery Suite) 1.Age > 35 yrs 2.Obesity (BMI>30kg/m2) 3.Parity 3 4.Smoker 5. Elective Caesarean Section 6.MEDICAL CO-MORBIDITIES e.g. heart or lung disease; SLE; cancer; inflammatory conditions; Proteinuria >3g/24 hrs; Sickle Cell Disease; IVDU 7.Gross varicose veins 8. Current systemic infection 9. Immobility, e.g. paraplegia, SPD, long-haul travel 10 Pre-eclampsia 11.mid-cavity or rotational forceps 12.Prolonged labour (>24 hrs) 13.PPH > 1litre or Blood Transfusion 2 or more risk factors <2 risk factors Intermediate Risk At least 7 days postnatal prophylactic LMWH Low Risk EARLY Mobilisation and avoidance of dehydration. NB If persisting or > 3 risk factors consider extending prophylaxis with LMWH Green-top Guideline April 2009
20.
21.
22.
When should thromboprophylaxis
be interrupted for delivery?
23.
24.
25.
Thank you
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