PERIPARTUM PROPHYLAXIS OF THROMBOEMBOLISM

It is important to continue or introduce prophylaxis of thrombo-emboli sm before elective delivery or during labour if the incidence of post partum thrombo-embolism is to be reduced. Women with previous thrombo- embolism, genetic or acquired thrombophilia should receive intrapartum and post partum prophylaxis for at least six weeks. Those having oper ative delivery may require prophylaxis for a shorter period if there a re no other risk factors. Subcutaneous unfractionated or low molecular weight heparins are the anticoagulants of choice. Available evidence shows that the use of prophylactic heparin during the course of epidur al or spinal anaesthesia does not increase the risk of local haematoma although this remains an actively controversial area. To reduce the r isk of osteopenia associated with long-term therapy and relieve the wo men of the onus of Self-administered injections, heparin may be replac ed by warfarin post-partum even if the mother is breastfeeding but war farin dosage, unlike heparin, will require careful monitoring.