Compliance with a perinatal prophylaxis policy for prevention of venous thromboembolism after caesarean section

To assess physician compliance, before and after a quality improvement intervention, with a regional policy on postpartum thromboprophylaxis following Caesarean section (CS), and to compare clinical outcomes (reduction of venous thromboembolism or increase in postpartum bleeding) between groups.

We performed a retrospective chart review of deliveries by CS, 404 prior to and 451 subsequent to a quality improvement intervention. All subjects were classified as being at either moderate or high risk for venous thromboembolism based on a risk-factor assessment, and warranted postpartum thromboprophylaxis according to the regional policy. Data regarding thromboembolism risk factors, postpartum thromboprophylaxis received, and clinical outcomes were recorded.

Initial compliance with the regional policy was poor, but improved following the intervention. The use of intermittent pneumatic compression devices increased from 32% to 84% (P < 0.001), use of anticoagulation increased from 6.2% to 46% (P < 0.001), and full compliance with the policy increased from 1.7% to 30% (P < 0.001). Clinical outcomes were not significantly different between the groups.

A quality improvement intervention markedly increased physician compliance with a regional policy on postpartum thromboprophylaxis among women at moderate to high risk of venous thromboembolism after CS. Adverse clinical outcomes were infrequent in this small study population.