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NONPHARMACOLOGIC ALTERNATIVES — Graduated elastic compression stockings and pneumatic compression boots are the primary alternatives to pharmacologic prophylaxis. Although their role in decreasing VTE in pregnancy has yet to be defined, graduated elastic compression stockings have been shown to increase femoral vein flow in late pregnancy [65]. Pneumatic compression stockings improve blood flow, decrease stasis and increase blood flow in femoral vessels by 240 percent [66]. Pneumatic compression stockings also increase fibrinolysis by increasing levels of plasminogen activator [67]. In a meta-analysis of moderate risk nonpregnant patients undergoing surgery, these devices were shown to decrease the incidence of DVT by 60 percent [68]. As they have no hemorrhagic risk and have been effective as prophylaxis in surgical gynecologic oncology patients [69], pneumatic compression stockings should be an ideal device in at risk pregnant patients who are at prolonged bed rest or undergoing cesarean delivery.
SUMMARY AND RECOMMENDATIONS

Pregnancy is associated with an increased risk of thrombosis due to pregnancy related stasis, hypercoagulability, and vascular trauma. (See "Introduction" above).
Risk factors associated with venous thromboembolism (VTE) in pregnant and postpartum women are shown in Table 1 (show table 1). (See "Risk factors for thromboembolism" above).
We recommend antepartum thromboprophylaxis throughout pregnancy for women at high risk of VTE, unless the risk factor can be removed (Grade 1B). Candidates for antepartum prophylaxis include: selected women with acquired or inherited thrombophilias and women with idiopathic VTE during a previous pregnancy or in the nonpregnant state. (See "Antepartum VTE prophylaxis" above).
We recommend postpartum thromboprophylaxis for all women who received antepartum thromboprophylaxis and all women with a prior VTE (Grade 1B). We suggest postpartum thromboprophylaxis for women who are at high risk of VTE because of one or more risk factors from Table 1 (show table 1) (Grade 2C). (See "Postpartum VTE prophylaxis" above).
We suggest that clinicians use compression stockings and pneumatic boots in all patients undergoing a cesarean delivery who have additional risk factors for VTE (Grade 2B). (See "Cesarean delivery" above).
Use of low molecular weight heparin may increase the risk of epidural hematoma formation upon placement of a neuraxial anesthetic. For this reason, we suggest stopping therapy at 36 weeks or earlier if preterm delivery is anticipated (Grade 2B). (See "Anesthesia" above).
For most patients, anticoagulation is discontinued intrapartum. (See "Intrapartum management" above).
A variety of postpartum interventions for prophylaxis against thrombosis are available and may be used short- or long-term, depending upon the individual's specific clinical circumstances. (See "Postpartum management" above).

هذا عن الوقاية مع الحمل و طرق العلاج تكون متشابهه مع او دون اما الجراحة حل جذري