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Sharma Vidya MD; Welsh, Tia MD, MPH; Ramchand, Minakshi BS; Mercado, Ray DO
Obstetrics & Gynecology: May 2014
doi: 10.1097/01.AOG.0000447181.13888.e2
Tuesday, April 29, 2014: PDF Only
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INTRODUCTION: Although there is consensus about deep vein thrombosis (DVT) prophylaxis in the pregnant population, the decision about the same in postpartum women is left to the physicians' preference. This study was undertaken to compare the incidence of wound complications in selective compared with universal administration of anticoagulation in postcesarean delivery women. Secondary outcomes were any episode of DVT or pulmonary embolism (PE) during 2-week period.

METHODS: Women who had cesarean delivery as the method of delivery between March 1, 2009, and February 28, 2011, of were included in the study. All the participants were divided into two groups: 1) selective anticoagulation: anticoagulation depending on their DVT score; and 2) universal anticoagulation: anticoagulation irrespective of their DVT score.

RESULTS: Of 434 women in selective group, five had immediate wound complications and 45 women had delayed wound complications. Of 367 women in the universal group, eight had immediate wound complications and 37 had delayed wound complications. The two-sided P value was .744, considered not significant (odds ratio 1.073). There were two cases of diagnosed PE, one case of DVT, and one case of maternal mortality attributed to PE in the selective group, whereas there was none in the universal anticoagulation group.

CONCLUSION: Our data point to no difference in the rate of wound complications resulting from universal and selective anticoagulation, whereas there was a case of PE and one maternal mortality in the selective anticoagulation group. Hence, we strongly encourage universal pharmacological anticoagulation for all puerperal women after cesarean delivery.

Financial Disclosure: Vidya Sharma, MD, Tia Welsh, MD, MPH, Minakshi Ramchand, BS, and Ray Mercado, DO—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.