Patient Safety, VTE

Preventing Death Following Cesarean Delivery

A recent study of almost 400,000 pregnancies reveals risk factors for blood clots in pregnant and postnatal woman. In the study published in the American Society of Hematology journal Blood, researchers analyzed the pregnancies of women aged between 15 and 44 between January 1995 and July 2009.

The study “Risk Factors for First Venous Thromboembolism Around Pregnancy: A Population Based Cohort Study from the United Kingdom” was led by researchers at The University of Nottingham. They identified the following key risk factors — obesity, bleeding during pregnancy or labour, premature birth, and cesarean delivery — which increased the risk of venous thromboembolism (VTE).

VTE Risk Twice As Much Following Cesarean Delivery

Dr. Matthew Grainge, who led the research at the Division of Epidemiology and Public Health, University of Nottingham, says, “VTE is a rare but serious complication of pregnancy and childbirth. It affects around one or two pregnancies per 1,000 but, despite this, remains a leading cause of mortality in expectant and new mothers in developed countries.”

“For pregnant women, the risks of VTE is 4-5 times higher than women who are not pregnant,” says Dr. Andra James (Professor of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, University of Virginia School of Medicine). “Moreover, this risk is at least twice as much following cesarean delivery.”

Recommendations for Preventing VTE with Compression Devices

Recent recommendations issued by The American College of Obstetricians and Gynecologists (ACOG) look to reduce maternal mortality due to blood clots. These recommendations provide risk factors, such as history of VTE, obesity, hypertension and smoking, as well as risk prevention treatments. Additionally, the recommendations discuss the value of monitoring and how to treat suspected or acute cases of VTE.

“Fortunately,” says Dr. James, “risk factors for VTE can be reduced by simple and cost-effective measures, such as fitting inflatable compression devices on a woman’s legs before cesarean delivery and using inflatable compression sleeves until the woman is able to walk after delivery.”

Dr. John Keats (ex-officio member of ACOG’s Patient Safety and Quality Improvement Committee) agrees, “Ensuring the identification of pregnant women at-risk for VTE and applying measures to reduce VTE risks would assist in reducing blood clots, particularly for women following cesarean delivery.”

The Physician-Patient Alliance for Health & Safety, together with healthcare experts and patient safety advocates, will be developing a succinct checklist targeting VTE for women following cesarean and vaginal delivery, and the extension of  prophylaxis post discharge. PPAHS encourages the participation of healthcare providers in its development.

2 thoughts on “Preventing Death Following Cesarean Delivery

  1. The optimal duration of prophylaxis and the related issue of whether prophylaxis should be continued after hospital discharge are both unknown for the majority of hospitalized patients because of the paucity of studies examining this question. Furthermore, with shorter lengths of hospital stay (and, therefore, shorter durations of prophylaxis) than previously, as well as the greater morbidity of patients being discharged, some patients are at increased risk of VTE unless some post-discharge thromboprophylaxis is considered. Major orthopedic surgery constitutes one of the highest risk groups for VTE and is also an area where the duration of prophylaxis has been subjected to rigorous study. At least nine randomized controlled trials and at least four systematic reviews in patients who underwent hip and knee arthroplasty and hip fracture surgery have confirmed the benefit of post-hospital discharge thromboprophylaxis.

  2. Pingback: Physician-Patient Alliance for Health & Safety Announces Formation of Safety Checklist Group for VTE Patient Safety | NEWS.GNOM.ES

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