Pulmonary embolism after deep vein thrombosis following cesarean section: Risk factors and pharmacological management

Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) account for a significant proportion (1-2%) of maternal fatalities. The risk of thrombotic events increases five to ten times during pregnancy and is twenty times greater following a caesarian section. However, the actual rates of these conditions in India remain unclear. Pulmonary embolism resulting from postpartum DVT can lead to fatal outcomes. A major factor contributing to the progression from DVT to PE is often delayed or missed diagnosis. Data from a 30-year population-based study in the USA revealed a PE incidence of 47.9 per 100,000 women annually, with the risk rising more than 15-fold in the initial three months after childbirth compared to during pregnancy itself. Older postpartum women (aged 35 years and above) face a markedly higher risk than their younger counterparts. Diagnosing suspected PE during pregnancy relies primarily on clinical symptoms and signs. For management, the use of thromboprophylaxis after cesarean delivery has been proven effective in lowering maternal morbidity and death due to VTE. Management options include sequential mechanical compression, graduated compression stockings, Low Molecular Weight Heparin (LMWH), Unfractionated Heparin (UFH), and Fractionated Heparin (FH). Immediate treatment is essential once VTE is confirmed, starting with supportive care and prompt initiation of anticoagulation therapy. The Norwegian Society of Gynecology recommends administering LMWH prophylaxis for 4-8 days post-cesarean section.