Deep Venous Thrombosis in Pregnancy and the Puerperium

EDITORIAL COMMENT: How have we done so well in preventing maternal deaths from pulmonary thromboembolism when most deaths from this cause are judged to be unavoidable? The number of maternal deaths from thromboembolism in Australia has fallen 90% in the 7 reported triennial 44 (1964–1966), 43 (1967–1969), 22 (1970–1972), 11 (1973–1975), 13 (1976–1978), 8 (1979–1981), 4(1982–1984). The remarkable reduction in the death rate has continued although the Caesarean section rate, an acknowledged contributing cause, has continued to increase. How important is the reduction in the number of grand multiparas? In high risk patients (previous deep vein thrombosis, previous pulmonary thromboembolism) prophylactic therapy (aspirin, anticoagulation with heparin or warfarin) is indicated during pregnancy and for about 6 weeks after delivery, but prophylactic anticoagulation therapy in all patients having Caesarean section, in the Editor's opinion, is definitely not indicated — when he was a Resident Medical Officer at the Royal Women's Hospital, Melbourne, in 1957, routine prophylactic anticoagulation therapy with heparin was used in gynaecology patients having radical hysterectomy and in patients having Caesarean section. These were the days when the death rate from thromboembolism was a great deal higher than now. This therapy was abandoned because of the complications of the use of heparin short‐term, namely, haemorrhage into wounds. We should remember lessons learned by past mistakes. This paper provides a good review of those aspects of patient care in modern obstetrics that probably account for the considerable reduction in what was for many years the leading cause of maternal death in Australia and the United Kingdom.