Abstract Preventing venous thromboembolism (VTE) in obstetrics remains challenging, with cases still occurring despite preventive measures. The aim of this study is to investigate the underlying causes by analyzing potential issues in current postpartum VTE prevention strategies in China. This retrospective study was conducted in our hospital from May 2021 to August 2024. VTE risk was assessed using the Chinese Expert Consensus on VTE Prevention and Treatment during Pregnancy and Puerperium (Chinese Consensus), and preventive measures were implemented accordingly. Clinical variables, timing of prophylaxis, and the predictive accuracy of the Chinese Consensus were analyzed. The VTE group had higher D-dimer levels and longer hospital stays and shorter gestational ages (P