Prevention of Venous Thromboembolism in Pregnancy and the Puerperium: A Comparative Review of Guidelines
Bibliographic record
Abstract
ABSTRACT Importance Venous thromboembolism (VTE), presenting either as deep vein thrombosis or as pulmonary embolism, is one of the leading causes of maternal morbidity and mortality. Objective The aim of this study was to review and compare the most recently published international guidelines providing recommendations on the prevention of VTE in pregnancy and the puerperium. Evidence Acquisition A comparative review of guidelines by the American College of Obstetricians and Gynecologists, the Royal College of Obstetricians and Gynecologists, the Royal Australian and New Zealand College of Obstetricians and Gynecologists, the Society of Obstetricians and Gynecologists of Canada, the American College of Chest Physicians, the European Society of Cardiology, and the American Society of Hematology on VTE was conducted. Results There is an overall agreement among the reviewed guidelines regarding the optimal anticoagulation and dosage choice, the management of low-molecular-weight heparin relating to neuraxial blockade, the importance of implementing risk assessment scores in every individual, and certain indications for obstetric thromboprophylaxis. On the other hand, controversy exists regarding management of unfractionated heparin before and after regional anesthesia, cases where calf compression stockings are suitable and indications where thrombophilia screening is required. Moreover, discrepancies exist in relation to management strategies in women with specific inherited thrombophilias. Notably, specific risk assessment scores are presented only by the Royal College of Obstetricians and Gynecologists, the Royal Australian and New Zealand College of Obstetricians and Gynecologists, and the Society of Obstetricians and Gynecologists of Canada. Conclusions As VTE remains a significant factor affecting maternal morbidity and mortality, worldwide, developing consistent international algorithms is of utmost importance to safely guide clinical practice and consequently improve pregnancy outcomes. Target Audience Obstetricians and gynecologists, family physicians Learning Objectives After participating in this activity, the learner should be better able to describe preventive strategies for VTE in pregnancy and the puerperium; discuss how to choose the appropriate anticoagulant regimens for pregnancy and puerperium; and identify the main risk factors for VTE in pregnancy and the puerperium.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.033 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.013 | 0.014 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".