Pulmonary embolism accounts for 11% of maternal deaths in the UK; frequently risk factors for venous thromboembolism (VTE) were identified. The RCOG now recommends that all pregnant women be appropriately risk assessed and then offered appropriate thromboprophylaxis.
A prospective audit was undertaken to ascertain women's satisfaction – both with the information provided, training received and subsequent compliance with thromboprophylaxis (to include graded compression stockings (GCS) and low molecular heparin (LMWH).
High risk women, who were identified within the first trimester and commenced on thromboprophylaxis (LMWH and GCS), were reviewed at approximately 36 week's gestation. They were asked to complete a satisfaction/compliance questionnaire. Data was collected on 25 women over 6 months. The majority of women (80%) had a previous history of VTE and/or Antiphospholipid Syndrome (APLS). Most, but not all women, appreciated why they were offered thromboprophylaxis. Many felt that they had received sufficient information and adequate training for both methods. Whilst many women reported bruising with LMWH, it was otherwise well tolerated and women were generally very compliant. One woman reported forgetting, and 4 reported running out of injections occasionally. In contrast the GCS were, for many, too uncomfortable and few women wore them continuously (40%).
Thromboprophylaxis is important for women identified as being at increased risk of VTE. It therefore follows that compliance is vital if such thromboprophylaxis is to be effective. Whilst LMWH is well accepted, this is not so for GCS. Further larger studies, outside the specialised clinic setting from which these women were recruited, is required.
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