Clinical feature | UKMEC Accept No restrictions | UKMEC Caution Additional preparation | UKMEC Delay Evaluate, treat or observe | UKMEC Special Specialized staff and facilities required |
|---|
Pregnancy | — | — | Pregnancy | — |
Age | — | Young age (particularly < 30 years) | — | — |
Parity | Parous | Nulliparous | — | — |
Postpartum | Breastfeeding | At the time of caesarean section | After vaginal delivery or emergency Caesarean section | — |
Post-abortion | — | — | Post-abortion (spontaneous and induced) | — |
Ectopic pregnancy | History of ectopic pregnancy | — | — | — |
Smoking | Previous or current smoker | — | — | — |
Obesity | — | BMI >= 30kg/m2 | — | — |
Blood pressure | History of high blood pressure during pregnancy | Adequately controlled hypertension Consistently elevated blood pressure: systolic > 140–159 mmHg or diastolic > 90–94 mmHg | — | Consistently elevated blood pressure: systolic >= 160 mmHg, or diastolic >= 95 mmHg Vascular disease including angina, intermittent claudication, hypertensive retinopathy, transient ischaemic attacks |
Surgery | History of pelvic surgery Major surgery without prolonged immobilization Minor surgery without immobilization | Sterilization concurrent with abdominal surgery: elective | Major surgery with prolonged immobilization Sterilization concurrent with abdominal surgery: emergency without previous counselling Sterilization concurrent with abdominal surgery and with an infectious condition | Previous abdominal or pelvic surgery |
Other risk factors for venous thromboembolism | History of VTE Family history of VTE in a first-degree relative Known thrombogenic mutations, e.g. factor V Leiden, prothrombin mutation, protein S, protein C, antithrombin deficiencies Varicose veins Superficial thrombophlebitis | — | Current VTE (on anticoagulants) Immobility (unrelated to surgery), e.g. wheelchair use, debilitating illness | Coagulation disorders |
Raynaud's disease | Primary Secondary, with and without lupus anticoagulant | — | — | — |
Headaches | Non-migrainous headaches; mild or severe Migraine headaches with or without aura History of migraine with aura at any age | — | — | — |
Epilepsy | — | Epilepsy | — | — |
Psychological conditions | — | Depressive disorders | — | — |
Breast disease | Undiagnosed mass Benign breast disease or a family history of breast cancer Carriers of known gene mutations associated with breast cancer (e.g. BRCA1) History of breast cancer and no evidence of recurrence for 5 years | Current breast cancer | — | — |
Vaginal bleeding | Irregular, heavy, or prolonged bleeding | — | Unexplained vaginal bleeding (before evaluation), suspicious for serious condition | — |
Other gynaecological conditions | Benign ovarian tumours, including cysts Severe dysmenorrhoea Gestational trophoblastic neoplasia when hCG is normal Cervical ectropion Cervical intraepithelial neoplasia (CIN) | Uterine fibroids, with or without distortion of the uterine cavity | Ovarian cancer Gestational trophoblastic neoplasia when hCG is abnormal Cervical cancer, awaiting treatment Endometrial cancer | Endometriosis Fixed uterus due to previous surgery or infection |
Cardiovascular conditions | — | History of ischaemic heart disease Stroke Uncomplicated valvular and congenital heart disease | Current ischaemic heart disease | Multiple risk factors for arterial cardiovascular disease Valvular and congenital heart disease complicated (e.g. by pulmonary hypertension, atrial fibrillation, or history of subacute bacterial endocarditis) |
Gastrointestinal conditions | History of cholestasis: related to pregnancy or to use of combined oral contraceptive Gallbladder disease: symptomatic treated by cholecystectomy, or medically treated Asymptomatic gall bladder disease Viral hepatitis: carrier | Cirrhosis: mild (compensated) Liver tumours: benign and malignant | Gall-bladder disease: current symptomatic Viral hepatitis: active | Cirrhosis: severe (decompensated) Inflammatory bowel disease |
Hernia | — | Diaphragmatic hernia | — | Abdominal wall or umbilical hernia |
Infections | Past pelvic inflammatory disease (assuming no known current risk factors for STIs) with subsequent pregnancy Schistosomiasis, uncomplicated Non-pelvic tuberculosis Malaria Other STIs (excluding HIV and hepatitis) Increased risk of STI's Vaginitis High risk of HIV or HIV-infected Viral hepatitis: carrier | Past pelvic inflammatory disease (assuming no known current risk factors for STIs) without subsequent pregnancy Schistosomiasis, with fibrosis of liver | Current purulent cervicitis or chlamydial infection or gonorrhoea Current pelvic inflammatory disease Local infection (abdominal skin infection) Systemic infection Gastroenteritis Viral hepatitis: active | AIDS and using HAART Known pelvic tuberculosis |
Diabetes | History of gestational disease | NIDDM and IDDM, non-vascular disease | — | With nephropathy, retinopathy, or neuropathy, or other vascular disease Other vascular disease Duration > 20 years |
Thyroid | Simple goitre | Hypothyroid | — | Hyperthyroid |
Haematological conditions | — | Thalassaemia Sickle cell disease Iron-deficiency anaemia: haemoglobin level 7–10 g/dL | Iron-deficiency anaemia: haemoglobin level < 7 g/dL | — |
Dyslipidaemia | Known hyperlipidaemias | — | — | — |
Respiratory diseases | — | — | Acute bronchitis orpneumonia | Chronic asthma, bronchitis, emphysema, lung infection |
Severe nutritional deficiencies | — | Severe nutritional deficiencies | — | — |
Kidney disease | — | Kidney disease | — | — |
BMI = body mass index; CIN = cervical intraepithelial neoplasia; HAART = highly active antiretroviral therapy; hCG = human chorionic gonadotrophin; IDDM = insulin-dependent diabetes; NIDDM = non-insulin-dependent diabetes; STI = sexually transmitted infection; VTE = venous thromboembolism. |