Venous Thromboembolism (VTE) is the formation of a blood clot in a deep vein, also referred to as deep vein thrombosis (DVT), and includes a very serious complication, pulmonary embolism (PE).  Thrombotic pulomary embolism (TPE) is a type of VTE that occurs when a clot travels through the blood stream to the lungs. TPE is one of the leading causes of maternal morbidity and mortality. Nearly all of these deaths (97%) had at least some chance of preventability and more than half of them (52%) had a good-to-strong chance.(1)

Findings from the 2008-2016 CA-PMSS data show that TPE accounted for 7% (n=43) of all maternal deaths, with an overall pregnancy related mortality risk of 0.9 maternal deaths per 100,000 live births.(2) All patients need to be assessed throughout pregnancy and postpartum to identify those at high risk who may benefit from pharmacological thromboprophylaxis. 

References

(1) The California Pregnancy-Associated Mortality Review. Report from 2002-2007 Maternal Death Reviews. Sacramento: California Department of Public Health--Maternal, Child, and Adolescent Health Division. 2017.
(2) CA-PMSS Surveillance Report: Pregnancy-Related Deaths in California, 20082016. Sacramento: California Department of Public Health--Maternal, Child, and Adolescent Health Division. 2021.

 

Improving Health Care Response to Maternal Venous Thromboembolism Toolkit

The Improving Health Care Response to Maternal Venous Thromboembolism Toolkit was developed in 2018 (reaffirmed in 2025) by the Venous Thromboembolism Task Force to encourage and facilitate systematic implementation of VTE risk assessment in California maternity units.

The antepartum outpatient and postpartum extended duration VTE prophylaxis strategies as presented represent a consensus summary of ACOG and the American College of Chest Physicians (ACCP) guidelines. These strategies serve as examples of a risk-based prophylaxis approach and current treatment recommendations.

Download Improving Health Care Response to Maternal Venous Thromboembolism Toolkit (2018, Reaffirmed 2025)

Beginning April 30, toolkits and related resources on our website will require a CMQCC Account login. First, locate the toolkit/resource on the website. Click on the toolkit/resource, and you will be prompted to log in or create an account. After you’ve logged in, you’ll automatically see an option to complete the download. Questions or need help? Email us at info@cmqcc.org. (Note: This is a different email than for MDC support!)

References Reviewed for Reaffirmation (April 2025)

  • Blondon M, Claver M, Celetta E, Righini M, de Tejada BM. Preventing Postpartum Venous Thromboembolism With Low-Molecular-Weight Heparin: The PP-HEP Pilot Randomised Controlled Trial. BJOG. 2025 Jan;132(1):35-43. doi:10.1111/1471-0528.17943.
  • Bruno AM, Sandoval GJ, Hughes BL, et al. Postpartum Pharmacologic Thromboprophylaxis and Complications in a US Cohort. Am J Obstet Gynecol. 2024;231:128.e1-11.
  • Champion ML, Blanchard CT, Lu MY, Shea AE, Lively AI, Jenkins JM, Howell SE, Lee GM, Casey BM, Battarbee AN, Subramaniam A. A More Selective vs a Standard Risk-Stratified, Heparin-Based, Obstetric Thromboprophylaxis Protocol. JAMA. 2024;332(4):310-317.
  • Chirumbole DL, Gandhi M, Clark SL, et al. Pharmacologic Venous Thromboembolism Prophylaxis for Preterm Prelabor Rupture of Membranes. Am J Obstet Gynecol MFM. 2024;6:101393.
  • Frank AK, Samuelson Bannow B. Venous Thromboembolism in Pregnancy and Postpartum: An Illustrated Review. Res Pract Thromb Haemost. 2024;8(4):102446. doi:10.1016/j.rpth.2024.102446.
  • Friedman AM & D'Alton ME. Expert Review: Prevention of Obstetrical Venous Thromboembolism. American Journal of Obstetrics and Gynecology. 2021;225(3), 228–236. doi:10.1016/j.ajog.2021.05.004.
  • Kilkenny K, Frishman W. Venous Thromboembolism in Pregnancy: A Review of Diagnosis, Management, and Prevention. Cardiol Rev. 2024 Jul 25. doi:10.1097/CRD.0000000000000756.
  • Lu MY, Blanchard CT, Ausbeck EB, Oglesby KR, Page MR, Lazenby AJ, et al. Evaluation of a Risk-Stratified, Heparin-Based, Obstetric Thromboprophylaxis Protocol. Obstet Gynecol. 2021;138:530–8. doi:10.1097/AOG.0000000000004521.
  • Mok T, Nguyen AV, Kwan L, Steinberg I, Vallera C, Silverman NS, Rao R. Prophylactic Unfractionated Heparin in Antepartum Hospitalizations: A Randomized Controlled Trial. Obstet Gynecol. 2024;144(1):118-125. doi:10.1097/AOG.0000000000005599.
  • Lindqvist PG, Westerlund E, Hellgren M. Swedish Obstetric Thromboprophylaxis Guideline: Background and Update. Journal of Obstetrics and Gynaecology. 43:2, 2241527. doi:10.1080/01443615.2023.2241527.
  • Shields LE, Feldman D, Klein C, Foster M, Lin S. Venous Thromboembolism Prophylaxis Should Be Recommended for Antepartum Admissions and Cesarean Delivery if Age and Body Mass Index Are Greater Than 35. Am J Perinatol. 2025;42(2):231-237. doi:10.1055/a-2342-0919.