title: Adherence to a guideline for coumarins in pregnancy.
abstract: OBJECTIVE
  To asses the adherence in daily clinical practice to a guideline for anticoagulation during pregnancy.
  
  
  METHODS
  The Dutch anticoagulation clinics developed a pregnancy guideline for anticoagulant therapy in order to avoid foetal exposure to coumarins between the 6th and 9th week of gestation. Anticoagulation was studied in 282 prospectively-registered pregnant women, who were treated by 26 different anticoagulation clinics.
  
  
  RESULTS
  The guideline was adhered to in 93% of treated women. Conforming to the guideline, the majority of patients commenced anticoagulation with heparin in the first trimester (n = 81) or started treatment from the second trimester onwards (n = 168). At the time of conception, 31 anticoagulated women were on coumarin treatment. In 13 of these patients (42%), coumarins were withdrawn before the 6th gestational week. In two pregnant women coumarin therapy started unintentionally during the first trimester of gestation.
  
  
  CONCLUSIONS
  The present study shows that the guideline under study is useful in daily clinical practice. A careful instruction of women of child-bearing age who need medication remains important.
authors.affiliation: Department of Paediatrics, Beatrix Children's Hospital, University Hospital, Groningen, The Netherlands.
authors.forename: Dieneke
authors.initials: D
authors.lastname: van Driel
authors.forename: Judit
authors.initials: J
authors.lastname: Wesseling
authors.forename: Kirsten
authors.initials: K
authors.lastname: ter Huurne
authors.forename: Lya M
authors.initials: LM
authors.lastname: Geven-Boere
authors.forename: Frits R
authors.initials: FR
authors.lastname: Rosendaal
authors.forename: Eveline
authors.initials: E
authors.lastname: van der Veer
authors.forename: Lolkje T W
authors.initials: LT
authors.lastname: de Jong-van den Berg
mesh_terms: D000328:Adult; D003374:Coumarins / Q000592:standards* / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008499:Medical Records; D010349:Patient Compliance; D017410:Practice Guidelines as Topic / Q000592:standards*; D011247:Pregnancy; D011446:Prospective Studies
chemical_list: D003374:Coumarins