A comparison of recommendations for pharmacologic XXXX prophylaxis after caesarean delivery from three major guidelines.

@entity1 @entity6677 @entity28 @entity1031 @entity1468 @entity1211
OBJECTIVE: Guidelines for pharmacologic @entity1211 ( @entity1211 ) prophylaxis from the American Congress of Obstetricians (ACOG), the Royal College of Obstetricians and Gynaecologists (RCOG), and the American College of Chest Physicians (Chest) vary significantly. The objective of this study was to determine the practical implications of these recommendations in terms of prophylaxis rates for a tertiary obstetric population. STUDY DESIGN: Cross-sectional. SETTING: Tertiary referral hospital. POPULATION: @entity1 post-operative day 1 after caesarean delivery. METHODS: This cross-sectional study evaluated rates of pharmacologic prophylaxis for @entity1 based on RCOG, ACOG, and Chest recommendations. Medical, obstetric, and demographic risk factors for @entity1031 were reviewed for individual @entity1 . Rates of prophylaxis based on each of the guidelines with 95% confidence intervals were calculated. OUTCOME MEASURE: Recommended pharmacologic prophylaxis. RESULTS: About 293 @entity1 were included in the analysis. Under RCOG guidelines, 85.0% of @entity1 would receive post-caesarean pharmacologic prophylaxis [95% confidence interval (CI) 80.5-88.6%] compared with 1.0% of @entity1 under ACOG guidelines (95% CI 0.3-3.0%) and 34.8% of @entity1 under Chest guidelines (95% CI 29.6-40.4%). Caesarean during labour, @entity28 , advanced maternal age, @entity1468 , and @entity6677 were among the most commonrisk factors. CONCLUSION: Recommended prophylaxis differed significantly. Under ACOG recommendations a small minority of @entity1 would receive prophylaxis, whereas under RCOG recommendations a large majority of @entity1 would receive low-molecular-weight heparin. Given the large differences in prophylaxis rates for post-caesarean thromboprophylaxis based on different guidelines, further research is urgently needed to compare the risks and benefits of recommendations. TWEETABLE ABSTRACT: Recommendations from major society guidelines for post-caesarean thromboprophylaxis differ greatly.
