1. Safety and assessment period
Are there any new symptoms that currently raise suspicion of VTE? Select an option No Yes I don’t know
Is there active bleeding or a significant risk of bleeding known to the physician? Select an option No Yes I don’t know
Scoring table Select an option Ministry of Health — Risky Pregnancies Management Guide 2026 RCOG 37a — September 2026 interim update
Evaluation period Select an option Pregnancy (prenatal) Postpartum (postpartum)
Pregnancy period Select an option First trimester Second / third trimester
In the postpartum evaluation, mark only the results of the current birth. Future cesarean section/bleeding during pregnancy is not scored.
2. Personal history and measurements
Age (years)
BMI at the beginning of pregnancy (kg/m²)
Parity: number of births that have occurred (including this birth during puerperium)
Number of cigarettes per day (0 if non-smoking)
Previously confirmed VTE Select an option No Single event: associated with major surgery Other / recurrent / unprovoked / estrogen-pregnancy related I don’t know
Physician-defined thrombophilia Select an option No known thrombophilia Heterozygous Factor V Leiden or prothrombin G20210A (single defect) Antithrombin/protein C-S deficiency, homozygous or multiple defects Antiphospholipid syndrome (APS) Type unknown / not sure
Routine thrombophilia testing is not required. MTHFR and PAI-1 variants are not included in this VTE scoring. In previous VTE and specific thrombophilia groups, the total score alone does not determine the treatment plan.
Are anticoagulants currently used? Select an option No Yes I don’t know
Is there any specific safety concern regarding LMWH allergy / HIT, low platelets, bleeding disorder, recent stroke, severe kidney/liver disease, severe uncontrolled hypertension, or birth/anesthesia? Select an option No Yes I don’t know
Unprovoked or estrogen-related VTE in a first-degree relative Comorbidity: cancer, heart failure, active SLE/inflammatory bowel disease/inflammatory polyarthropathy, nephrotic syndrome, Type 1 diabetes with nephropathy, sickle cell disease, or current IV drug dependence (this group is scored once) Ministry: varicose veins (including pelvic varicose veins) that are prominent on the kneecap, are larger than 1 cm in diameter, and cause discoloration of the skin. Is there a transient risk factor (surgery / OHSS / hyperemesis requiring hospitalization / systemic infection / immobilization–dehydration) that resolved within the last 7 days? Select an option No Yes I don’t know
In the RCOG, additional time after risk correction is also considered, even if the score decreases.
4. Temporary risks that still apply
Do not flag an old risk that has been eliminated. Cesarean section also counts in the mode of birth field; Do not count the same surgery as “additional surgery” again.
Hospitalization during pregnancy; Is there a ≥3-day long stay or readmission in the puerperium? Select an option No Yes I don’t know
Additional surgery other than cesarean section and episiotomy-perineal repair during pregnancy / puerperium (e.g. appendectomy, postpartum sterilization) Active hyperemesis: especially inability to take in fluids / severe vomiting that limits movement
Active ovarian hyperstimulation syndrome (OHSS) in the first trimester
Current systemic infection (RCOG: requiring IV antibiotics or hospitalization) Immobilization / dehydration (Ministry: immobilization ≥3 days; RCOG: conditions of prolonged immobilization and temporary risk) Journey longer than 4 hours (1 point at Ministry; no separate score line in Annex I of RCOG September 2026) Perform the following verification before unchecked fields are automatically considered “none”. If you are unsure, complete the assessment with your healthcare team.