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Mechanical Thromboprophylaxis Compliance Postcesarean Delivery: A Prospective Quality Assurance Analysis

Ludlow Katherine D. MD; D'Alton, Mary E. MD; Friedman, Alexander M. MD
Obstetrics & Gynecology: May 2014
doi: 10.1097/01.AOG.0000447148.97747.c3
Tuesday, April 29, 2014: PDF Only

INTRODUCTION: Thromboembolism remains a leading cause of maternal morbidity and mortality. Subcutaneous compression devices serve as a clinically effective, cost-effective, noninvasive means of thromboprophylaxis. Use of these devices perioperatively during cesarean delivery is supported by the American College of Obstetricians and Gynecologists. Unfortunately, data from other fields suggest that appropriate use and patient compliance with these devices may be suboptimal. The objective of this study was to determine postoperative subcutaneous compression device compliance in women who have undergone cesarean delivery and evaluate causes of noncompliance.

METHODS: This prospective quality assurance analysis evaluated subcutaneous compression device compliance between 5 and 7 AM postoperative day 1 for women who underwent cesarean delivery at a single tertiary center. Institutional review board approval was obtained. Clinical and demographic risk factors for thromboembolism were abstracted. Factors leading to patient noncompliance were evaluated.

RESULTS: One hundred sixty-six patients from May to July 2013 were included in the analysis. A total of 19.9% of patients were noncompliant with subcutaneous compression device use. Reasons for noncompliance included patient discomfort, machine malfunction, and incorrect device use. Patients who were noncompliant had similar risk factors for thromboembolism compared with women who were compliant.

CONCLUSION: Although an effective method of thromboprophylaxis in postoperative patients, subcutaneous compression device use demonstrated suboptimal compliance in postcesarean delivery patients. These findings are similar to those from other fields. Quality assurance should be undertaken to evaluate appropriate subcutaneous compression device use and develop strategies to improve compliance. For patients who are noncompliant with subcutaneous compression devices and at risk for thromboembolism, pharmacologic prophylaxis may be considered.

Financial Disclosure: Katherine D. Ludlow, MD, Mary E. D'Alton, MD, and Alexander M. Friedman, MD—These authors have no conflicts of interest to disclose relative to the contents of this presentation.

© 2014 by The American College of Obstetricians and Gynecologists.