Although the number of deaths from VTE has declined markedly following the 1995 RCOG guidelines on thromboprophylaxis after caesarean section, the Eighth report on Confidential Enquiries into Maternal Deaths re-emphasizes a need to increase awareness of risk factors and application of appropriate management. In the last report, 11 of 18 deaths from thrombosis and/or thromboembolism had occurred in women who had received suboptimal risk assessment and thromboprophylaxis.
The aim of the audit was to assess compliance with local trust guidelines on thromboprophylaxis assessment and administration after caesarean section.
A prospective study was conducted over 12 days on the maternity unit. The clinical notes of all patients who delivered by caesarean section were assessed for completion of thromboprophylaxis assessment, as well as appropriate prescription and timely administration of low weight-molecular heparin.
A total of 52 patients were reviewed. Only 70% of patients were assessed for thromboprophylaxis at admission, while 90% were assessed after delivery. All patients were administered Dalteparin as thromboprophylaxis after caesarean section. The mean duration for commencing Dalteparin was 8 h 43 min after delivery.
On the whole, most of the audit standards were met and thromboprophylaxis was commenced in all patients. However, in light of financial constraints and patient safety, the benefit of universal thromboprophylaxis should be weighed against potential risks and cost effectiveness. The need for thromboprophylaxis in low-risk patients could be reconsidered in future.
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