Synopsis
Recognise thromboembolism after birth, distinguish prevention from therapeutic anticoagulation, and coordinate investigation, breastfeeding-compatible treatment and a safe post-discharge medication plan.
- Postpartum thrombosis risk remains important after discharge from maternity care.
- Reassess prevention needs after infection, haemorrhage, surgery or readmission.
- Prophylactic low-molecular-weight heparin does not treat an established clot.
- Investigate suspected thrombosis promptly with appropriate objective imaging.
- Treatment must satisfy both total duration and postpartum coverage requirements.
- Warfarin and heparins can be used during breastfeeding.
Key red flags
Sudden unexplained shortness of breath or pleuritic chest pain.
Collapse, hypoxaemia or haemodynamic instability after delivery.
New unilateral painful leg swelling, especially involving the whole limb.
Neurological symptoms or unusual severe headache suggesting a different venous thrombosis site.
Investigation priorities
Confirm or exclude a suspected lower-limb venous clot.
Management branches
New symptoms suggest DVT or pulmonary embolism after birth.
- Arrange urgent hospital evaluation, document vital signs and identify immediate bleeding or neuraxial contraindications.
- Start therapeutic LMWH while objective testing is arranged unless contraindicated, involving senior clinicians when competing risks complicate treatment.
- Use the appropriate DVT or PE imaging pathway and clearly document the plan if an initial result is negative or incomplete.
Key medicines
Enoxaparin for therapeutic anticoagulationA standard adult treatment schedule is 1 mg/kg subcutaneously every 12 hours; confirm the maternity weight-based regimen and adjust for renal impairment. Continue the agreed therapeutic course, including any planned oral transition.Check active bleeding, platelet history, renal function and recent spinal or epidural procedures. Prophylactic 40 mg daily is not an equivalent treatment dose; severe renal impairment requires specialist dosing.
Enoxaparin postpartum prophylaxisRCOG's suggested prophylactic dose for a woman weighing 50–90 kg is 40 mg subcutaneously once daily; other weights need different doses. Prescribe 10 days or 6 weeks according to risk assessment.Start only when bleeding and neuraxial safety allow. Confirm local timing rules after regional anaesthesia; reassess dose with renal impairment or extreme weight and extend duration if significant risks persist.