title: Venous thromboembolism prophylaxis during and following caesarean section: a survey of clinical practice.
abstract: BACKGROUND
  Caesarean section (CS) is a significant risk factor for venous thromboembolism; however, the optimal method of thromboprophylaxis around the time of CS is unknown.
  
  
  OBJECTIVE
  To examine current thromboprophylaxis practice during and following CS in Australia and New Zealand, and the willingness of obstetricians to participate in a randomised controlled trial (RCT) comparing different methods of thromboprophylaxis after CS.
  
  
  METHODS
  An online survey was sent to fellows and trainees of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
  
  
  RESULTS
  There were 488 responses from currently practising obstetricians (response rate 23.4%). During CS, 48% and 80% of obstetricians recommended intermittent pneumatic compression (IPC) and elastic stockings (ES), respectively. Following CS, 96-97% of obstetricians recommended early ambulation, 87-90% recommended ES, 23-36% recommended IPC, and 42-65% recommended low molecular weight heparin (LMWH) depending on clinical factors. Increased BMI (OR 3.42; 95% CI 2.87-4.06), emergency CS (OR 1.88; 95% CI 1.67-2.16) and older maternal age (OR 1.37; 95% CI 1.26-1.49) were associated with more frequent LMWH use. Of obstetricians who prescribed LMWH, 70% adjusted the dose depending on maternal weight. LMWH therapy was most commonly recommended until discharge from hospital (31%), <5 days (24%) and 5-7 days (15%). Most obstetricians (58-79%) were willing to enrol women in a RCT, but less likely if the woman had an increased BMI or emergency CS.
  
  
  CONCLUSIONS
  There is considerable variation in clinical practice regarding thromboprophylaxis during and following CS. Obstetricians support a RCT to assess different methods of thromboprophylaxis following CS.
authors: Clinical and Population Perinatal Health Research, Kolling Institute, St Leonards, New South Wales, Australia.|Sydney Medical School Northern, University of Sydney, St Leonards, New South Wales, Australia.|Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
authors: Sean K M
authors: SK
authors: Seeho
authors: Clinical and Population Perinatal Health Research, Kolling Institute, St Leonards, New South Wales, Australia.|Sydney Medical School Northern, University of Sydney, St Leonards, New South Wales, Australia.|Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
authors: Tanya A
authors: TA
authors: Nippita
authors: Clinical and Population Perinatal Health Research, Kolling Institute, St Leonards, New South Wales, Australia.|Sydney Medical School Northern, University of Sydney, St Leonards, New South Wales, Australia.
authors: Christine L
authors: CL
authors: Roberts
authors: Clinical and Population Perinatal Health Research, Kolling Institute, St Leonards, New South Wales, Australia.|Sydney Medical School Northern, University of Sydney, St Leonards, New South Wales, Australia.|Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
authors: Jonathan M
authors: JM
authors: Morris
authors: Clinical and Population Perinatal Health Research, Kolling Institute, St Leonards, New South Wales, Australia.|Sydney Medical School Northern, University of Sydney, St Leonards, New South Wales, Australia.
authors: Natasha
authors: N
authors: Nassar
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D001315:Australia; D002585:Cesarean Section; D003131:Combined Modality Therapy; D004434:Early Ambulation / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D048228:Intermittent Pneumatic Compression Devices / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D011183:Postoperative Complications / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D053828:Stockings, Compression / Q000706:statistics & numerical data; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight
keywords: Caesarean section; clinical practice variation; prophylaxis; thromboembolism