Financial implications and maternal impact of national recommendations for thromboprophylaxis: a retrospective...

Thromboembolism was a leading direct cause of maternal death in the UK in the last Saving Mothers' Lives report. National guidance proposes that all women should be risk assessed in pregnancy and after delivery.

An audit was designed to assess the financial implication for our service. One hundred consecutive live and stillbirths were identified using the maternity database; 97 case records were obtained. Risk factors were identified and individual scores were calculated, together with the proportion that would have extended measures (low-molecular-weight heparin [LMWH], antiembolic stockings).

The series appeared to be representative of the UK pregnant population in terms of age, parity, body mass index, smoking and caesarean rate. Antenatally, 2.1% had a Royal College of Obstetricians and Gynaecologists (RCOG) risk score of three or more and would have been advised to have LMWH throughout pregnancy and the puerperium. Postnatally, 40.1% had an RCOG score of two or more and would have required enoxaparin for one to six weeks. The annual cost of stockings, LMWH and sharps bins approximate to GB£44,847 for every one thousand deliveries, GB£2.6 million for each life saved. About 10% of normal-weight postnatal women who achieved a vaginal birth had a risk score prompting thromboprophylaxis for at least seven days.

These data suggest that the current guidance might represent overmedicalization of pregnancy and that the criteria for thromboprophylaxis should be refined further.