Venous thromboembolism prophylaxis around the time of caesarean section: a survey of current practice. — The Association Specialists
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Venous thromboembolism prophylaxis around the time of caesarean section: a survey of current practice. (289)

Tanya Nippita 1 2 , Sean Seeho 1 2 , Natasha Nassar 1 , Christine Roberts 1 , Jonathan Morris 1 2
  1. Perinatal and Population Health, Kolling Institute, Sydney, NSW, Australia
  2. Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St Leonards, NSW, Australia

BACKGROUND

Pregnancy, the postpartum period and caesarean section (CS) are risk factors for venous thromboembolism (VTE). Although rare, VTE is a leading cause of maternal death in Australia. There is a lack of data regarding VTE prophylaxis around the time of caesarean birth.

AIM

This study aims to describe the practice of obstetricians with regards to VTE prophylaxis during and following caesarean birth.

METHODS

An online survey was sent to all Fellows and Trainees of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). Questions were related to VTE prophylaxis use based on various scenarios and intention to include patients in randomised controlled trials.

RESULTS

Of those emailed, 596 (28%) responded. During CS, 49% recommended intermittent calf compression and 80% graduated or thromboembolic deterrent (TED) stockings compared to 25% and 88%, respectively following CS. Low molecular weight heparin (LMWH) use varied, with 42-65% of respondents recommending LMWH for any length of time postpartum. Factors that increased usage of LMWH were BMI (OR 1.7; 95%CI 1.6-1.9) and after emergency CS (OR 1.3 95%CI 1.2-1.4). Maternal age or preeclampsia did not impact practice. 58-79% of respondents would be willing to recruit patients to a randomised trial, but were less likely if patients had an increased BMI or an emergency CS.

CONCLUSION

There is variation in use of non-pharmacological and pharmacological methods of VTE prophylaxis for women around the time of CS, with LMWH more likely to be utilised for women with increased BMI and after emergency CS.