Thrombophylaxis and bleeding complications after cesarean section.
OBJECTIVE
To evaluate the safety of different regimes of thromboprophylaxis with low molecular weight heparins (LMWHs) in women undergoing cesarean section.


METHODS
Retrospective single-center cross-sectional study.


METHODS
University Medical Center, The Netherlands.


METHODS
All women that delivered by cesarean section in the Erasmus Medical Center, Rotterdam, between January 2004 and December 2007 received thromboprophylaxis. We included women who received thromboprophylaxis according to the routine administration schedule at that time.


METHODS
Three different consecutive regimes of thromboprophylaxis were used. In the first period, women received dalteparin 5000IU pre- and postoperatively (group A), in the second period, nadroparin 5700IU was administered pre- and postoperatively (group B), and in the third period, nadroparin 2850IU was administered not earlier than 6-12 hours postoperatively (group C). Detailed information on individual characteristics, cesarean section and postpartum period were extracted from patient files.


METHODS
Postoperative bleeding complications.


RESULTS
A total of 1527 women were eligible and included. In group B, significantly more women experienced bleeding complications (necessitating either conservative treatment or re-laparotomy) compared with the other two groups (19/574 women in group B vs. 9/647 in group A and 1/306 in group C). After adjusting for potential confounders (maternal age, body mass index, and occurrence of preeclampsia/hemolysis, elevated liver enzymes and low platelet count) these effects remained significant (p=0.005). The incidence of thromboembolism was not different in the three groups.


CONCLUSIONS
Different regimes of thromboprophylaxis in women with cesarean section influenced the occurrence of bleeding complications.
Department of Obstetrics and Gynecology, Erasmus University Medical Center, Dr. Molewaterplein 60, Rotterdam, the Netherlands.
Claudia A
CA
Snijder
Jerôme M W
JM
Cornette
Wim C J
WC
Hop
Marieke J H A
MJ
Kruip
Johannes J
JJ
Duvekot
D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D017985:Dalteparin / Q000008:administration & dosage* / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D017762:Nadroparin / Q000008:administration & dosage* / Q000009:adverse effects; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D011247:Pregnancy; D012189:Retrospective Studies; D013923:Thromboembolism / Q000453:epidemiology
D005343:Fibrinolytic Agents; D017762:Nadroparin; D017985:Dalteparin