Thromboprophylaxis after caesarean section

Abstract

Background and aims: - 41 maternal deaths directly due to thromboembolism reported in 2003-05 triennium (CEMACH report) - PE remains leading direct cause of maternal death in UK - Pregnancy is a risk factor for VTE - Some women are at even higher risk due to one or more factors - Pre-existing: Previous VTE, Thrombophilia disorders, Obesity (BMI {>}30 kg m-2 at booking), Age {>} 35 years, Parity {>} 4, Sickle cell disease Aim: - To assess compliance with NICE {&} RCOG guidelines relating to thromboprophylaxis following Caesarean section - To recommend improvements in practice to achieve improved compliance Methods: - 36 women included; none excluded-Elective = 14 (39{%}) - Emergency = 22 (61{%})- Number of women with more than one risk factor = 6- Other conditions noted- Gestational diabetes (2),Hepatitis B (2),Placenta praevia (1),Thalassaemia(1)- Intravenous drug abuse (1)- Was Clexane prescribed in the drug chart? Yes = 33 (91.7{%}) No = 3 (8.3{%})-Was the dose of Clexane prescribed the correct dose for the patient's body weight? Yes = 26 (78.8{%}) No = 7 (21.2{%})Of these, 4 had ≥2 risk factor. Conclusions: - NICE guideline on antenatal care recommends that every woman should have her BMI calculated at the first antenatal visit-Clexane was not prescribed in 8.3{%} of cases, and was incorrectly prescribed in 21.2{%} - New guidelines are urgently needed for thromboprophylaxis for morbidly obese women - Risk assessment in early pregnancy must include identification of morbid obesity and other risk factors.