EGPRN primary care research at a crossroads advancing research on interprofessional collaboration and on integrated, equitable and complex care. An EGPRN Keynote Paper from the Autumn 2025 Plovdiv Con

Venous thromboembolism (VTE) during pregnancy, encompassing deep venous thrombosis (DVT) and pulmonary embolism (PE), is a significant contributor to maternal mortality. The incidence of pregnancy-associated VTE ranges from 0.5 to 2.0 per 1,000 pregnancies, with an associated mortality rate of approximately one per 100,000 deliveries. Pregnancy is traditionally regarded as a hypercoagulable state, characterized by increased fibrin generation, decreased fibrinolytic activity, and elevated levels of coagulation factors II, VII, VIII, and X. Additionally, free protein S levels are reduced, and there is often acquired resistance to activated protein C. These changes lead to a rise in pro-coagulation factors, diminished thrombolytic activity, and lowered anticoagulant protein function, which collectively result in higher rates of thromboembolic events during pregnancy and the postpartum period. Approximately 80% of these events are venous, while 20% are arterial. Women experience a heightened risk of VTE during pregnancy and the first six weeks postpartum compared to their non-pregnant counterparts. This risk escalates gradually throughout pregnancy, peaking during the first one to two weeks after childbirth, before gradually declining and significantly decreasing around the sixth week post-delivery. The majority of postpartum VTE cases are linked to thrombophilia and deliveries via Cesarean section. Additionally, preeclampsia further elevates the risk of postpartum VTE. Women with a personal history of VTE are at a greater risk of experiencing VTE associated with pregnancy.