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Routine thromboembolism risk assessment and use of both pharmacologic and mechanical thromboprophylaxis is an important part of obstetrics care, according to new recommendations from the National Partnership for Maternal Safety.
Although obstetric venous thromboembolism (VTE) remains a common cause of maternal morbidity and mortality, prophylaxis recommendations are varied and nonspecific across obstetric organizations. The new maternity safety bundle from the National Partnership for Maternal Safety (NPMS) aims to eliminate some of the confusion.
“Based on increasing maternal risk of obstetric venous thromboembolism in the United States, the failure of current strategies to decrease venous thromboembolism as a proportionate cause of maternal death, and observational evidence from the United Kingdom that risk factor–based prophylaxis may reduce risk, the NPMS working group has interpreted current epidemiology and clinical research evidence to support routine thromboembolism risk assessment and consideration of more extensive risk factor–based prophylaxis,” the authors wrote (Obstet Gynecol. 2016;128:688-98).
In the recommendations, prophylactic management of obstetric thromboembolism is organized into four categories: readiness, recognition, response, and reporting and systems learning.
The readiness component includes a recommendation to use a standard thromboembolism risk assessment tool at the first prenatal visit, all antepartum admissions, immediately post partum during childbirth hospitalization, and on discharge from the hospital after a birth. The Caprini and Padua scoring systems, which are tools designed for nonobstetric hospitalized patients, can be modified for obstetric patients, according to the recommendations.
The recognition component of the bundle emphasizes the use of education and guidelines to help physicians identify obstetric patients at risk for thromboembolism. The response component proposes a thromboembolism risk assessment at the first prenatal visit, followed by the use of standardized recommendations for mechanical thromboprophylaxis, dosing of prophylactic and therapeutic pharmacologic anticoagulation, and appropriate timing of pharmacologic prophylaxis with neuraxial anesthesia.
The reporting and systems learning component calls for reviews of a sample of a facility’s obstetric population to determine comorbid risk factors for VTE, followed by routine auditing of records to monitor risk assessment programs and patient care.
The NPMS suggests applying the American College of Chest Physicians recommendations for hospitalized, nonsurgical patients to pregnant women and postpartum women who have had a vaginal birth. However, they recommend using the American College of Obstetricians and Gynecologists’ guidelines for pregnant and postpartum women with thrombophilia.
The NPMS also recommends that women receiving pharmacologic VTE prophylaxis plus low-dose aspirin for the prevention of preeclampsia, should discontinue aspirin at 35-36 weeks of gestation.
“Given the wide diversity of birthing facilities, a single national protocol is not recommended; instead, each facility should adapt a single protocol to improve maternal safety based on its patient population and resources,” the NPMS members wrote.
The NPMS is a joint effort including leaders from a range of women’s health care organizations, hospitals, professional societies, and regulators.
The authors reported having no financial disclosures.
Routine thromboembolism risk assessment and use of both pharmacologic and mechanical thromboprophylaxis is an important part of obstetrics care, according to new recommendations from the National Partnership for Maternal Safety.
Although obstetric venous thromboembolism (VTE) remains a common cause of maternal morbidity and mortality, prophylaxis recommendations are varied and nonspecific across obstetric organizations. The new maternity safety bundle from the National Partnership for Maternal Safety (NPMS) aims to eliminate some of the confusion.
“Based on increasing maternal risk of obstetric venous thromboembolism in the United States, the failure of current strategies to decrease venous thromboembolism as a proportionate cause of maternal death, and observational evidence from the United Kingdom that risk factor–based prophylaxis may reduce risk, the NPMS working group has interpreted current epidemiology and clinical research evidence to support routine thromboembolism risk assessment and consideration of more extensive risk factor–based prophylaxis,” the authors wrote (Obstet Gynecol. 2016;128:688-98).
In the recommendations, prophylactic management of obstetric thromboembolism is organized into four categories: readiness, recognition, response, and reporting and systems learning.
The readiness component includes a recommendation to use a standard thromboembolism risk assessment tool at the first prenatal visit, all antepartum admissions, immediately post partum during childbirth hospitalization, and on discharge from the hospital after a birth. The Caprini and Padua scoring systems, which are tools designed for nonobstetric hospitalized patients, can be modified for obstetric patients, according to the recommendations.
The recognition component of the bundle emphasizes the use of education and guidelines to help physicians identify obstetric patients at risk for thromboembolism. The response component proposes a thromboembolism risk assessment at the first prenatal visit, followed by the use of standardized recommendations for mechanical thromboprophylaxis, dosing of prophylactic and therapeutic pharmacologic anticoagulation, and appropriate timing of pharmacologic prophylaxis with neuraxial anesthesia.
The reporting and systems learning component calls for reviews of a sample of a facility’s obstetric population to determine comorbid risk factors for VTE, followed by routine auditing of records to monitor risk assessment programs and patient care.
The NPMS suggests applying the American College of Chest Physicians recommendations for hospitalized, nonsurgical patients to pregnant women and postpartum women who have had a vaginal birth. However, they recommend using the American College of Obstetricians and Gynecologists’ guidelines for pregnant and postpartum women with thrombophilia.
The NPMS also recommends that women receiving pharmacologic VTE prophylaxis plus low-dose aspirin for the prevention of preeclampsia, should discontinue aspirin at 35-36 weeks of gestation.
“Given the wide diversity of birthing facilities, a single national protocol is not recommended; instead, each facility should adapt a single protocol to improve maternal safety based on its patient population and resources,” the NPMS members wrote.
The NPMS is a joint effort including leaders from a range of women’s health care organizations, hospitals, professional societies, and regulators.
The authors reported having no financial disclosures.
Routine thromboembolism risk assessment and use of both pharmacologic and mechanical thromboprophylaxis is an important part of obstetrics care, according to new recommendations from the National Partnership for Maternal Safety.
Although obstetric venous thromboembolism (VTE) remains a common cause of maternal morbidity and mortality, prophylaxis recommendations are varied and nonspecific across obstetric organizations. The new maternity safety bundle from the National Partnership for Maternal Safety (NPMS) aims to eliminate some of the confusion.
“Based on increasing maternal risk of obstetric venous thromboembolism in the United States, the failure of current strategies to decrease venous thromboembolism as a proportionate cause of maternal death, and observational evidence from the United Kingdom that risk factor–based prophylaxis may reduce risk, the NPMS working group has interpreted current epidemiology and clinical research evidence to support routine thromboembolism risk assessment and consideration of more extensive risk factor–based prophylaxis,” the authors wrote (Obstet Gynecol. 2016;128:688-98).
In the recommendations, prophylactic management of obstetric thromboembolism is organized into four categories: readiness, recognition, response, and reporting and systems learning.
The readiness component includes a recommendation to use a standard thromboembolism risk assessment tool at the first prenatal visit, all antepartum admissions, immediately post partum during childbirth hospitalization, and on discharge from the hospital after a birth. The Caprini and Padua scoring systems, which are tools designed for nonobstetric hospitalized patients, can be modified for obstetric patients, according to the recommendations.
The recognition component of the bundle emphasizes the use of education and guidelines to help physicians identify obstetric patients at risk for thromboembolism. The response component proposes a thromboembolism risk assessment at the first prenatal visit, followed by the use of standardized recommendations for mechanical thromboprophylaxis, dosing of prophylactic and therapeutic pharmacologic anticoagulation, and appropriate timing of pharmacologic prophylaxis with neuraxial anesthesia.
The reporting and systems learning component calls for reviews of a sample of a facility’s obstetric population to determine comorbid risk factors for VTE, followed by routine auditing of records to monitor risk assessment programs and patient care.
The NPMS suggests applying the American College of Chest Physicians recommendations for hospitalized, nonsurgical patients to pregnant women and postpartum women who have had a vaginal birth. However, they recommend using the American College of Obstetricians and Gynecologists’ guidelines for pregnant and postpartum women with thrombophilia.
The NPMS also recommends that women receiving pharmacologic VTE prophylaxis plus low-dose aspirin for the prevention of preeclampsia, should discontinue aspirin at 35-36 weeks of gestation.
“Given the wide diversity of birthing facilities, a single national protocol is not recommended; instead, each facility should adapt a single protocol to improve maternal safety based on its patient population and resources,” the NPMS members wrote.
The NPMS is a joint effort including leaders from a range of women’s health care organizations, hospitals, professional societies, and regulators.
The authors reported having no financial disclosures.
FROM OBSTETRICS & GYNECOLOGY
