Preventing blood clots in pregnant mothers poses significant health care challenges. The risk of blood clots in pregnant mothers is almost ten times more likely than a non-pregnant woman. These patient safety risks increase for pregnant mothers who are obese. In the United States, more than two-thirds of adults are obese.
Because of the increased risk of blood clots in pregnant mothers, the Physician-Patient Alliance for Health & Safety (PPAHS) released a podcast with Lisa Enslow, MSN, RN-BC. Ms. Enslow is the Nurse Educator for the Women’s Health and Ambulatory Care Services at Hartford Hospital in Hartford Connecticut.
“Pregnant women are at a significantly higher risk than the general public for developing a blood clot simply because of the mechanisms that are in place to help them prevent hemorrhaging,” said Ms. Enslow. “So, our pregnant patients really need a lot more risk assessment during their hospitalization and even after discharge. If a blood clot is not detected or treated, it may become dislodged and travel up into the lung and that can create even more problems for the mom.”
In the podcast, Ms. Enslow discusses a super morbidly obese pregnant mother (identified as Mrs. M). This mother had a BMI (body mass index) of 67 BMI of 18.5 to 24.9 is considered normal.
Four keys for managing the health care risk in obese pregnant mothers were identified during the podcast.
The first key – plan for the delivery.
Ms. Enslow explained the necessity of planning – “Pre-planning and communication between all of the team members is really key to achieving the most optimal clinical outcomes for patients with multiple challenging risk factors or individual characteristics. In specialties, such as obstetrics, we’re often faced with a complex patient that requires us to be really proactive and identifying risk factors early in the course of care. This type of preparedness is necessary to prevent adverse events and to identify individual risk factors that would best guide us in the management or plan for patients possible hospital acquired conditions or in adverse event prevention plans to achieve high quality outcomes.”
The second key – apply blood clot preventative measures.
Ms. Enslow described the measures taken in a case of super morbidly obese pregnant mother – “this patient fell into the high risk category for venous thromboembolism because of her multiple risk factors, including the high BMI, her gestational diabetes, her maternal age, or having a caesarean section. So, because of this, she was provided with sequential compression devices beginning in the operating room … [The sequential compression devices] stayed on throughout the recovery period in our PACU and also when the patient was transferred to the postpartum unit … We started chemical prophylaxis six hours following surgery for her and that was continued throughout her stay.”
The third key – preventing blood clots doesn’t stop when the mother leaves the hospital.
Ms. Enslow emphasized the importance of preventative measures when the mother returns to her home – “it’s important to remember that the commitment to prevent VTE doesn’t end when the patient is discharged. That’s why appropriate patient education is so important to help patients understand why they should comply with their care, with making sure they understand that they really need to continue taking their discharge medications. Our post-partum patients can get the sequential compression devices for use at home and need to keep all their follow-up appointments.”
The fourth key – use the OB VTE Safety Recommendations.
The OB VTE Safety Recommendations were developed with the advice and counsel of a panel of experts brought together by the Physician-Patient Alliance for Health & Safety. They provide four concise steps that:
- Assess patients for VTE risk with an easy-to-use automated scoring system
- Provide the recommended prophylaxis regimen, depending on whether the mother is antepartum or postpartum.
- Reassess the patient every 24 hours or upon the occurrence of a significant event, like surgery.
- Ensure that the mother is provided appropriate VTE prevention education upon hospital discharge.
“Caring for Mrs M. was significantly helped by the guidance from the recently released OB VTE Safety Recommendations, which offers a fine clinical process that covers the entire continuum of care,” said Ms. Enslow.
The OB VTE Safety Recommendations are a free resource available on the PPAHS website – http://www.ppahs.org
The podcast was hosted by Pat Iyer, MSN, RN, LNCC. Ms. Iyer is a legal nurse consultant who provides education to healthcare providers about patient safety at www.patiyer.com.
For a transcript of the podcast, please click Taking the Challenge Out of Managing the Complex Obstetric Patient.