**Abstract**

Venous thromboembolism (VT is a major cause of maternal mortality and severe morbidity. Pharmacological and non-pharmacological methods of prophylaxis are therefore often used for women considered to be a risk including women who have given birth by cesarean section. The risk is potentially increased in women with a personal or family history of VTE, women with genetic or acquired thrombophilia, and another risk factors like sickle cell disease, inflammatory bowel disease, active cancer, obesity, preeclampsia·and SARS COVID 19 infection. However, a specific score in obstetrics has not yet been well defined. Recommendations from major society guidelines for post-cesarean section (C/S) thromboprophylaxis differ greatly; the safety and efficacy of drug prophylaxis - mainly low molecular weight heparins - has been demonstrated, but large scale randomized trials of currentlyused interventions should be conducted. The purpose of this chapter is to discuss the indications and contraindications for VTE prophylaxis in cesarean sections, prophylaxis regimens and potential adverse events.

**Keywords:** VTE, DVT, cesarean section, thromboprophylaxis, heparin

### **1. Introduction**

Venous thromboembolism (VTE) is a major cause of maternal morbidity and mortality. The risk of VTE is particularly elevated during the postpartum period and especially after cesarean section (CS) delivery. The risk of VTE was fourfold greater following CS than following vaginal delivery; seemed independent of other VTE risk factors; and was greater following emergency CS than following elective procedures [1].

Although a number of risk factors have been identified, the size of the increases in risk attributable to these factors is generally poorly quantified and there is considerable variation in the approach to prophylaxis of venous thromboembolism after CS [2–5].

In women with risk factors a combination of pharmacological and nonpharmacological methods are recommended. There is limited literature on the effect of mechanical methods for postpartum thromboprophylaxis, however benefit has been shown in other clinical areas [2, 4].

Antithrombotic prophylaxis are based on unfractionated heparin (UFH), lowmolecular weight heparin (LMWH). LMWH was associated with fewer adverse effects when compared with UFH. Therefore, LMWH is considered to be a safe and effective in for postpartum thromboprophylaxis, although high-quality evidence is not available [1, 2].

In this chapter we will discuss the risk factors for VTE, their interactions and potential risk scores, as well as the prophylaxis alternatives and international guidelines for the prevention of VTE.
