Published: 2019-02-26

The risks for thromboembolism following caesarean section

Veena R., Radhamani M. V., Deepa S.


Background: Maternal mortality can be due to various reasons. Maternal mortality following thromboembolism is a cause for concern. Venous thromboembolism is a very serious condition following caesarean section. Thromboprophylaxis should be given to the mothers with high risk for thromboembolism, who deliver by caesarean section. The objective of this study was to do to assess the risk status for thromboembolism among women delivered by caesarean section.

Methods: A hospital based cross- sectional study was conducted among four hundred mothers who delivered by caesarean section. The study was conducted for a period of eight months from January to August 2017. The risks for thromboembolism was assessed and as per the guideline and hospital policy, thromboprophylaxis was given.

Results: Out of four hundred patients, medical comorbidities were present for three patients. Patients who were overweight were 122. Two had systemic infection. The number of patients with high, intermediate and low risk of venous thromboembolism were 4,65 and 331.

Conclusions: The study suggests that thromboprophylaxis is to be given for all the patients with any risk for thromboembolism, after caesarean section.


High risk, Intermediate risk, Thromboembolism, Thromboprophylaxis

Full Text:



Nelson-Piercy C, MacCallum P, Mackillop L. Reducing the risk of thrombosis and embolism during pregnancy and puerperium. Royal College of Obstetricians and Gynaecologists, green-top Guidelines. No 37a April 2015; Available at:

James AH. Prevention and management of venous thromboembolism in pregnancy. Am J Med. 2007;12(10):S26-34.

Gidiri M, Sant M, Philips K, Lindow SW. Thromboprophylaxis for caesarean section- how can uptake and coverage be improved?. J Obstet Gynaecol. 2004;24(4):392-4.

Cavazza S, Rainaldi MP, Adduci A, Palareti G. Thromboprophylaxis following caesarean delivery: One site prospective pilot study to evaluate the application of a risk score model. Thrombosis Res. 2012;129(1):28-31.

Crowley MP, Noone C, Higgins JR, O’ Shea S. A multicentre study of thromboprophylaxis in Pregnancy. Ir Med J. 2017;110(5):567.

Shakuntala PN, Jhancy AD, Rabia M, Shalini N, SK S, PadminiIsacc SR. Risk Scoring and Appraisal of Thromboprophylaxis following emergency caesarean section- A pilot study. Int J Health Scienc Res. 2013;3(8):22-30.

Blondon M. Thromboprophylaxis after caesarean section: decision analysis. ThrombRes.2011;127(3): S9-12.

Tomialowicz M, Florjanski J, Zimmer M, Pajak J, Klosek A. Assessment of the effectiveness of using low molecular weight heparin in the prophylaxis of venous thrombo-embolic diseases in obstetrics. Ginekol Pol. 2000;71(9):1115-9.

Lau CQH, Wong TCT, Tan EL, Kanagalingam D. A review of caesarean section techniques and postoperative thromboprophylaxis at a tertiary hospital. Singapore Med J. 2017;58(6):327-31.

Paily VP, Anbujam K, Rajasekharan Nair V, Thomas B. Confidential review of maternal deaths in Kerala: a country case study. BJOG: Int J Obstetrics Gynaecol. 2014;121(s4):61-6.

James AH. Pregnancy-associated thrombosis. Hematol.2009;2009(1):277-85

Jacobsen A, Drolsum A, Einar Klow N, Dahl G, Qvigstad E, Sandset PM. Deep vein thrombosis after elective caesarean section. Thrombosis Res. 2004;113:283-8.

Rudigoz RC, Arnaud MF, Dargent D, Magnin P. The risk of thrombo-embolism in pregnancy and in the post-partum period. A review of 28,828 pregnancies author’s transll. J Gynecol Obstet Biol Reprod. 1981;10(2):155-61.

Jacobsen AF, Skjeldestad FE, Sandset PM. Ante- and post-natal factors of venous thrombosis: a hospital-based case-control study. J Thromb Haemost.2008;6(6):905-12

Jacobsen AF, Skjeldestad FE, Sandset PM. Incidence and risk patterns of venous thromboembolism in pregnancy and puerperium- a register-based case-control study. Am J Obstetr gynecol. 2008;198(2):233-e1.

Malinowski AK. Bomba-Opon D, Parrish J, Sarzynska U, farine D. Venous thromboembolism in obese pregnant women: approach to diagnosis and management. Ginekol Pol. 2017;88(8):453-9.

Robinson HE, O’Connell CM, Joseph KS, McLeod NL. Maternal outcomes in pregnancies complicated by obesity. Obstet Gynecol. 2005;106(6):1357-64.

Danilenko-Dixon DR, Heit JA, Silverstein MD, Yawn BP, Petterson TM, Lohse CM, et al. Risk factors for deep vein thrombosis and pulmonary embolism during pregnancy or post-partum: A population-based case control study. Am J Obstet Gynecol. 2001;184(2):104-10.

Baeten JM, Bukusi EA, Lambe M. Pregnancy complications and outcomes among overweight and obese nulliparous women. Am J Public Health. 2001;91:436-40.

Sebire NJ, Jolly M, Harris JP, Wadsworth J, Joffe M, Beard RW, et al. Maternal obesity and pregnancy outcome: A study of 287,213 pergnancies in London. Int J Obes Relat Metab Disord. 2001;25:1175-82.

Perlow JH, Morgan MA. Massive maternal obesity and perioperative cesarean morbidity. Am J Obstet Gynecol. 1994;170:560-5.

Edwards LE, Hellerstedt WL, Alton IR, Story M, Himes JH. Pregnancy complications and birth outcome in obese and normal weight women: effects of gestational weight change. Obstet Gynecol. 1996;87:389-94.

Blondon M, Casini A, Hoppe KK, Boehlen F, Righini M, Smith NL.Risks of Venous Thromboembolism After Cesarean Sections: A Meta-Analysis. Chest Journal.2016;150:572-96.

Joyce Lai, Isvarya Venu, Ann Kinga Malinowski, Shital Gandhi, Anne McLeod, Rosane Nisenbaum, et al. Thromboembolism following cesarean section: a retrospective study, Hematol.2018;23:6, 351-6.

Seeho SK, Nippita TA, Roberts CL, Morris JM, Nassar N. Venous thromboembolism prophylaxis during and following caesarean section: a survey of clinical practice. Aus New Zeal J Obstetr Gynaecol. 2016;56(1):54-9.