DOI 10.1515/jpm-2013-0160 J. Perinat. Med. 2013; x(x): xxx–xxx Salvatore Gizzo*, Marco Noventa, Omar Anis, Carlo Saccardi, Alessandra Zambon, Stefania Di Gangi, Daniela Tormene, Michele Gangemi, Donato D’Antona and Giovanni Battista Nardelli Pharmacological anti-thrombotic prophylaxis after elective caesarean delivery in thrombophilia unscreened women: should maternal age have a role in decision making? Abstract: In obstetrical practice, the best prevention strategy for pregnant women aged > 35 years without known thrombosis risk factors who underwent elective caesarean delivery (CD) is controversial. We performed an observational-longitudinal cohort study on preg- nant women aged > 35 years who delivered at term by elective caesarean section after a physiological single pregnancy to evaluate the role of maternal age in the decision-making process of whether or not to perform low-molecular-weight heparin (LMWH) prophylaxis dur- ing the post-partum period after elective CD in healthy women with unknown inherited thrombophilia status. During the 6 post-partum weeks, we followed two groups: GROUP-A (349 women treated for 7 days with low-molecu- lar-weight heparin) and GROUP-B (180 women not treated with LMWH treatment). The outcomes were as follows: onset of thromboembolic events during the post-partum period; non-obstetrical-linked maternal haemorrhage; blood transfusion; re-laparotomy; detection of a surgical site haematoma; length of hospitalisation; and treatment suspension because of decreased platelet count. Except for the parity number, the two groups were homogeneous with regard to general features. In both the groups, we reported no cases of thromboembolic events during the follow-up period. Maternal haemorrhage requiring trans- fusion occurred in 16 women in GROUP-A and none in GROUP-B. Among the GROUP-A women, 11 demonstrated a surgical site haematoma and 4 required re-laparotomy. No cases of treatment suspension were reported. Pneu- matic compression stockings represent a better, low cost and safe way to prevent post-partum venous thrombo- embolic episodes after elective caesarean section in an unscreened population. Pharmacological prophylaxis after elective caesarean section should be performed only in case of clear and known adjunctive risk factors, inde- pendent of maternal age. Keywords: Caesarean delivery; heparin; low-molecular- weight heparin; post-partum period; prophylactic anti- coagulant treatment; thromboembolic events; venous thromboembolism. *Corresponding author: Salvatore Gizzo, MD, Dipartimento di Salute della Donna e del Bambino, U.O.C. di Ginecologia e Ostetricia Via Giustiniani 3 35128 Padova, Italy, Tel.: +39 333 5727248, Fax: +39 049 8211785, E-mail: ginecologia_padova@libero.it Salvatore Gizzo, Marco Noventa, Omar Anis, Carlo Saccardi, Alessandra Zambon, Stefania Di Gangi, Michele Gangemi, Donato D’Antona and Giovanni Battista Nardelli: Department of Woman and Child Health, University of Padua, Padua, Italy Daniela Tormene: Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padua, Italy Introduction Venous thromboembolism (VTE) and pulmonary embol- ism (PE) are the leading causes of maternal mortality and morbidity in the developed countries during the post-par- tum period [7, 9]. Pregnant women are associated with an increased risk of VTE ranging from 5% to 10% compared to that of non-pregnant women [7, 18], particularly in the post-partum period [14, 16]. The most important risk factor for VTE in pregnancy is a personal history of thrombosis because 15%–25% of VTE in pregnancy result as recurrent events [17, 26]. The second strongest personal risk factor is thrombophilia, acquired and inherited (anti-thrombin deficiency, factor V Leiden homozygous or heterozygous, prothrombin G20210A homozygous or heterozygous). In fact, 20%–50% of women who developed a VTE episode during pregnancy and in the post-partum period were affected by thrombophilia [18, 26]. Several studies iden- tified other general risk factors (immobility, body mass index, BMI > 30 kg/m 2 , multiple pregnancy and smoking), Q1: Please check and confirm that the edited article title reads okay Q2: Is it okay to change Group-A and Group-B to Group A and Group B throughout the article? Please check and confirm Q3: Might it be better to supply entire address in English for concistency?