Audit of thromboprophylaxis in women undergoing caesarean section

Thromboembolism is a major cause of maternal mortality. Pregnancy is associated with an increased risk of thromboembolic diseases, with an even greater risk in women undergoing caesarean section. Since the introduction of the RCOG guidelines in 1995 on thromboprophylaxis for women undergoing caesarean section, there has been a significant reduction in the number of women dying from pulmonary embolism in the UK. The aims of our study was to conduct an audit cycle to assess our compliance with RCOG guidelines for thromboprophylaxis in women undergoing caesarean section to introduce changes in practice based on the observations of this audit, and to re-audit our practice to assess the effect of the changes. A retrospective audit of 100 women undergoing caesarean section was done in the Rotunda Hospital in June 2001. Changes in practice were introduced based on the findings of this audit. Obstetricians were asked to complete a checklist pre-operatively and to assign the patients a risk category-low, moderate or high. Prophylaxis was prescribed based on this risk assessment. Following the introduction of this change in practice, we re-audited 100 women delivered by caesarean section in June 2002. In the first audit, risk assessment was as follows: 20 low, 75 moderate and 5 high. Twenty-one of 75 (28%) of moderate risk patients in the first audit received appropriate prophylaxis. In the re-audit, risk assessment was as follows: 33 low, 66 moderate and 1 high. Following the introduction of new clinical practice, 45 of 66 (68%) of those in the moderate risk group received appropriate prophylaxis. All women in the low risk groups received appropriate prophylaxis in both audits. Our audit cycle of thromboprophylaxis in women undergoing caesarean section has demonstrated that the introduction of new clinical practice resulted in greater compliance with the RCOG guidelines, but further improvement could be achieved. These observations are discussed and recommendations are made to further improve compliance with RCOG guidelines.