Audit on the use of thromboprophylaxis during caesarean section

Thromboembolic disease is still a main cause of maternal morbidity and mortality. In 1995 the RCOG working party on prophylaxis against thromboembolism has suggested that patients undergoing caesarean section should have a risk assessment and be given heparin prophylaxis if deemed to be high risk. In Stepping Hill Hospital this was audited. The outcome was that 0% of emergency caesarean sections, and only 25% of elective caesarean sections who were considered to be high risk had heparin prophylaxis. A structured risk assessment form was introduced for every patient undergoing caesarean section and the outcome was re-audited; 72.7% and 85.7% of emergency and elective caesarean sections, respectively,that were deemed high risk had adequate heparin thromboembolic prophylaxis. Filling in a risk assessment form before performing a caesarean section reminds and reinforces the need to consider thromboprophylaxis. A risk assessment form has been formally incorporated into all the maternity case records.