Quality statement 8: Risk assessment – intermediate risk of venous thromboembolism

Quality statement 8: Risk assessment – intermediate risk of venous thromboembolism

Quality statement

Pregnant women at intermediate risk of venous thromboembolism at the booking appointment have specialist advice provided about their care.

Quality measure

Structure

a) Evidence of local arrangements to ensure that pregnant women have their risk of venous thromboembolism (VTE) assessed and recorded at the booking appointment.

b) Evidence of local arrangements to ensure that pregnant women at intermediate risk of VTE at the booking appointment have specialist advice provided about their care.

Data source: a) and b) Local data collection.

Process

a) Proportion of pregnant women accessing antenatal care who have their risk of VTE recorded at the booking appointment.

Numerator – the number of women in the denominator having their risk of VTE assessed and recorded at the booking appointment.

Denominator – the number of pregnant women accessing antenatal care.

b) Proportion of pregnant women at intermediate risk of VTE at the booking appointment who have specialist advice provided about their care.

Numerator – the number of women in the denominator with specialist advice provided about their care.

Denominator – the number of pregnant women at intermediate risk of VTE at the booking appointment.

Data source: a) and b) Local data collection.

Outcome

Incidence of VTE in pregnant women.

Data source: The Maternity Services Secondary Uses Dataset, once implemented, will collect data on VTE as a maternal critical incident (global number 17205700).

What the quality statement means for each audience

Service providers ensure that systems are in place to provide pregnant women who are at intermediate risk of VTE at the booking appointment with specialist advice.

Healthcare professionals seek or provide specialist advice for pregnant women at intermediate risk of VTE at the booking appointment.

Commissioners ensure they commission services which provide pregnant women at intermediate risk of VTE at the booking appointment with specialist advice.

Pregnant women who at the time of their booking appointment have a moderate risk of developing VTE (a blood clot) have specialist advice sought about their care.

Source guidance

Definitions

Definitions are taken from RCOG green-top guideline 37a.

Intermediate risk of VTE is defined as any of the following:

  • single previous VTE with no family history or thrombophilia (inherited or acquired)

  • thrombophilia (inherited or acquired) and no VTE

  • medical comorbidities such as:

    • heart or lung disease

    • systemic lupus erythematosus

    • cancer

    • inflammatory conditions

    • nephrotic syndrome

    • sickle cell disease

    • intravenous drug use

  • Surgical procedures such as appendicectomy

or 3 or more risk factors from the following list (or 2 or more risk factors from the following list if admitted to hospital):

  • age above 35 years

  • body mass index more than 30 kg/m2

  • parity 3 or more

  • smoker

  • gross varicose veins (symptomatic, above the knee or associated with phlebitis/oedema/skin changes)

  • current systemic infection

  • immobility (for at least 3 days) such as:

    • paraplegia

    • symphysis pubis dysfunction with reduced mobility

  • long-distance travel (greater than 4 hours)

  • pre-eclampsia

  • dehydration/hyperemesis/ovarian hyperstimulation syndrome

  • multiple pregnancy or assisted reproductive therapy.

Women assessed as being at intermediate risk should have specialist advice provided about their care. This would involve the healthcare professional responsible for the pregnant woman's care discussing the woman's risk factors with a specialist service (for example, a trust-nominated thrombosis in pregnancy expert or team) and acting on this advice.