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Thromboembolism has been the leading direct cause of maternal death in the UK since 1985, but while the number of deaths fell dramatically from 41 to 18 between 2003–2005 and 2006–2008, this improvement has not been sustained. In the 1990s, a previous fall occurred after the RCOG published recommendations on thromboprophylaxis at CS. Deaths during pregnancy and after vaginal delivery, however, continued to rise and these were targeted by a further RCOG guideline in 2004. These categories fell sharply in 2006–2008, the first full triennium after the new guideline was published. However deaths from thromboembolism have risen again and in 2016–2018 there were 33 (Figure 2.2).

Figure 2.2 Maternal mortality from venous thromboembolism, 3‐year rolling rates in the UK, 2010 to 2017

The most important risk factor for thromboembolism is obesity and the current guidance includes weight‐specific dosage advice on thromboprophylaxis. Risk assessment early in pregnancy is the key to reducing mortality further; this message needs to be heard in gynaecology wards and early pregnancy assessment units as well as in maternity units. However, a clear message from the 2020 report is that there remains confusion about risk assessment scores, which are done inaccurately in many of the cases reviewed.

The value of individualised care also needs to be emphasised. The 2006–2008 report stresses that vulnerable women, for example those with a learning disability, may not be able to follow instructions about self‐injection and will require particular care.

Chest symptoms (shortness of breath or discomfort/pain), ‘panic attacks’ or leg pains appearing for the first time in pregnancy or the puerperium need careful assessment, particularly in at‐risk women. This lesson needs to get across to other specialties.