Clinicians' Knowledge and Understanding of Pregnancy‐Related VTE Risk and Its Assessment in the UK : A Survey of Risk Perception in Complex Times

Venous thromboembolism (VTE) is the leading cause of maternal mortality in the UK during and within 6 weeks of the end of pregnancy. Despite considerable national attention to the importance of VTE-related morbidity and mortality during pregnancy and postpartum, and Royal College of Obstetricians and Gynaecologists (RCOG) guidelines that recommend timely VTE risk assessment and thromboprophylaxis, VTE-related maternal mortality remains at levels seen in the mid-1990s. As foundational work for an update of the current, 2015 RCOG guideline on VTE prevention in pregnancy and postpartum, we formally surveyed healthcare professionals in the UK. Over 90% of respondents felt confident using the guideline; but nevertheless more than one-third felt the current RCOG GTG-37a VTE risk scoring system is too complex, both antenatally and postnatally. Additional free-text responses emphasised the complexity of VTE risk assessment, and the need for simplification and specificity. Twenty-four percent of respondents overestimated the risk of developing VTE in pregnancy and postpartum, and 43% over-estimated the risk of dying from VTE. Also, clinicians felt a very high risk of developing VTE in pregnancy was needed to warrant thromboprophylaxis, with the average response suggesting a risk 50-times higher than the 10-20 per 10,000 baseline risk in pregnancy/postpartum. A challenge going forward is producing a simple and easy-to-use, evidence-based guideline that can facilitate shared-decision making and offer best clinical care.