Background: Venous thromboembolism (VTE) is a significant cause of maternal morbidity and mortality. National and international guidelines advocate the use of thromboprophylaxis following caesarean section (CS); however, current practice and the number of women who qualify for guideline-recommended thromboprophylaxis is unknown.
Objectives: To examine current thromboprophylaxis practice after CS in four tertiary hospitals in NSW, and to determine the proportion of women who would qualify for thromboprophylaxis if the Royal College of Obstetrics and Gynaecology (RCOG), Society of Obstetric Medicine of Australia and New Zealand (SOMANZ), or American College of Chest Physician (ACCP) guideline recommendations were followed.
Methods: A prospective audit was conducted over a three-month period, Oct 2014-Jan 2015 at Royal North Shore, Royal Prince Alfred, Westmead and Nepean hospitals.
Results: Overall, 1,402 women delivered by CS, of which 1003 (72%) were included in the study. There was wide between-hospital variation in the proportion of women administered low molecular weight heparin (LMWH) after CS, ranging from 24.2% to 95.6%. Of all women (574/1003) administered LMWH, 96.9% were prescribed enoxaparin 40 mg daily. LMWH was commonly recommended for two days (29.5%); three days (30.1%); and four days (20.9%). The proportion of women who had a CS and met guideline criteria for either early mobilisation or LMWH is shown in the Table. Eight out of 10 women would receive post-CS LMWH if there were adherence to RCOG recommendations; six out of 10 women would receive LMWH if SOMANZ recommendations were followed; and only one in four women would qualify for LMWH if ACCP recommendations were followed.
|
Guideline Recommendation |
|||
|
Guideline |
Early mobilisation +/- Graduated Compression Stockings |
Postnatal LMWH |
Extended Postnatal LMWH (6 weeks) |
|
RCOG |
19.1 % |
78.0% |
2.9% |
|
SOMANZ |
38.8% |
56.7% |
4.5% |
|
ACCP |
75.3% |
23.5% |
1.2% |
Conclusions: There is wide variation in clinical practice regarding post-CS thromboprophylaxis between hospitals. A larger proportion of women undergoing CS would qualify for LMWH if RCOG and SOMANZ recommendations were adhered to compared with ACCP recommendations.