Peripartum prophylaxis of thrombo-embolism.

It is important to continue or introduce prophylaxis of thrombo-embolism 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 operative delivery may require prophylaxis for a shorter period if there are 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 epidural or spinal anaesthesia does not increase the risk of local haematoma although this remains an actively controversial area. To reduce the risk of osteopenia associated with long-term therapy and relieve the women of the onus of self-administered injections, heparin may be replaced by warfarin post-partum even if the mother is breastfeeding but warfarin dosage, unlike heparin, will require careful monitoring.