Table 1 The evaluation of risk factors for thromboembolism during pregnancy and puerperium
From: Maternal mortality following thromboembolism; incidences and prophylaxis strategies
| Risk Factors | Score |
|---|---|
| A) Risk factors related to general conditions | |
| Body mass index (BMI) equal to or greater than 40 (before or during early pregnancy) | 2 |
| Age older than 35 years | 1 |
| BMI between 35 and 40 (before or early pregnancy / weight greater than 80 kg) | 1 |
| Parity ≥ 3 regardless of the current pregnancy | 1 |
| Smoking | 1 |
| Gross varicose veins (symptomatic or above the knee or with phlebitis, edema, skin changes) | 1 |
| B) Risk factors related to medical conditions | |
| History of previous VTE (except for the reason of major surgery) | 4 |
| Acquired thrombophilia (antiphospholipid antibody syndrome): at least one laboratory test and at least a clinical criterion | 4 |
| History of previous VTE due to major surgery | 3 |
| Any medical conditions: cancer, cardiac disease, active lupus, inflammatory poly-arthropathy or inflammatory bowel disease, nephrotic syndrome, type 1 diabetes mellitus with nephropathy, tuberculosis, current intravenous drug addiction | 3 |
| High risk inherited thrombophilia (deficiency of anti-thrombin, protein S or C deficiency, homozygote low risk thrombophilia or more than one heterozygote low risk thrombophilia) | 3 |
| Low risk inherited thrombophilia (heterozygote factor 5 Leiden, G20210A prothrombin gene mutation) | 1 |
| Family history of VTE in first degree relatives (spontaneous or estrogen dependent) | 1 |
| Anti-phospholipid antibodies (only laboratory criteria, without a clinical criteria) | 1 |
| C) Obstetrical Risk Factors | |
| Cesarean section in labor | 2 |
| Current preeclampsia | 1 |
| Pregnancy with fertility IVF / ART methods (only considered during pregnancy) | 1 |
| Multiple pregnancy | 1 |
| Non-emergency cesarean (elective) | 1 |
| Instrumental delivery | 1 |
| Prolonged labor (more than 24 h) | 1 |
| Postpartum hemorrhage (greater than 1 l / blood transfusion) | 1 |
| Preterm labor (less than 37 weeks) in the current pregnancy | 1 |
| Intrauterine fetal demise (IUFD) in the current pregnancy | 1 |
| D) Transient Risk Factors | |
| Ovarian hyper stimulation syndrome (only in the first trimester) | 4 |
| Surgery during pregnancy or postpartum (curettage, tubal closure, appendectomy..., except for perineal immediate repair) | 3 |
| Severe vomiting of pregnancy (hyperemesis) | 3 |
| Systemic infections (antibiotics or admission needed) foe example: pneumonia, pyelonephritis, postpartum wound infection | 1 |
| Hospitalization or immobilization (≥3 days rest in bed), dehydration | 1 |