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Am J Perinatol 2018; 35(09): 873-881
DOI: 10.1055/s-0038-1627098
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Postpartum Thromboembolism Prophylaxis during Delivery Hospitalizations

Audrey A. Merriam
1   Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York
2   Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, New York
,
Yongmei Huang
1   Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York
,
Cande V. Ananth
1   Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York
2   Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, New York
,
Jason D. Wright
1   Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York
,
Mary E. D'Alton
1   Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York
,
Alexander M. Friedman
1   Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York
› Author Affiliations Funding Dr. Friedman is supported by a career development award (K08HD082287) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health.
Further Information

Publication History

21 July 2017

29 December 2017

Publication Date:
02 February 2018 (online)

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Abstract

Objective This article evaluates trends in venous thromboembolism (VTE) prophylaxis during delivery hospitalizations in the United States.

Methods We utilized an administrative database to determine if women hospitalized for vaginal or cesarean delivery received pharmacologic VTE prophylaxis, mechanical VTE prophylaxis, or both from January 2011 through March 2015. Mechanical prophylaxis included sequential compression devices, graduated compression stockings, and other pneumatic devices. Pharmacologic prophylaxis included unfractionated heparin, low molecular weight heparin, or fondaparinux. Probability of use of thromboprophylaxis for individual hospitals was estimated in an adjusted model.

Results A total of 956,428 women who underwent cesarean and 1,914,142 women who underwent vaginal delivery were included in the analysis. Cesarean VTE prophylaxis declined between 2011 (50.3%) and 2015 (47.7%; p < 0.01). Of women undergoing vaginal delivery, 2.9% received prophylaxis. Delivery hospital was an important determinant of cesarean prophylaxis: in the adjusted model, one-third of hospitals used prophylaxis for less than 20% of deliveries, one-third of hospitals used prophylaxis for 20 to 80% of deliveries, and the final third of hospitals used prophylaxis in greater than 80% of deliveries.

Conclusion While many hospitals appear to be following best clinical practices, some do not provide routine cesarean VTE prophylaxis. Minimizing care quality variation may improve maternal safety.

Keywords

obstetric thromboembolism - severe maternal morbidity - thromboprophylaxis

Authors' Contributions

All authors fulfilled all conditions required for authorship and have approved of this submission. A.F. conceived the study question, study design, and wrote the manuscript. A.M. conceived the study question, study design, and wrote the manuscript. C.A. performed the statistical analysis and interpretation of the data. He also made substantial contributions in drafting the article and revising it critically. Y.H. performed the statistical analysis and interpretation of the data. J.W. made substantial contributions to the conception and design of the study as well as interpretation of the data. He also made substantial contributions in drafting the article and revising it critically. M.D. made substantial contributions to the conception and design of the study as well as interpretation of the data. He also made substantial contributions in drafting the article and revising it critically.


Ethical Approval

Since the database used in this study is a fully deidentified data set, the Institutional Review Board (IRB) at our institution did not require IRB approval to carry out this study.


 

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