International Journal of Clinical Pharmacy

, Volume 41, Issue 1, pp 264–271 | Cite as

Utilization of venous thromboembolism prophylaxis in American hospitalized pregnant women undergoing cesarean section

  • Tiffany K. PonEmail author
  • Natalie Wessel
  • Vincent Cagonot
  • Ronnie Delmonte
  • Denise Roach
  • Laurel Finta
Research Article


Background Pregnancy-related venous thromboembolism (VTE) is a leading preventable cause of maternal mortality in the United States; however, American guidelines for pharmacologic VTE prophylaxis remain less aggressive than other developed countries. The Safe Motherhood Initiative (SMI) combines aspects of American and international guidelines to increase utilization of prophylaxis and thereby decrease incidence of pregnancy-related VTE. Objectives To evaluate the prescribing and administration rates of pharmacologic VTE prophylaxis for women undergoing cesarean section (c-section) when retrospectively applying the SMI recommendations. Setting Large academic medical center in Sacramento, California, USA. Method This was a single-center retrospective cohort study of pregnant women undergoing c-section who would have met criteria for pharmacologic prophylaxis according to the SMI. Main outcome measures Prescribing and administration rates of mechanical and pharmacologic VTE prophylaxis. Secondary outcomes included incidence of thromboembolism within 6 weeks after c-section and thromboembolic associated mortality. Results A total of 616 charts were analyzed. When applying the SMI guidelines for VTE prophylaxis, the prescribing rates for mechanical and pharmacologic prophylaxis were 94.3% and 4.71% of patients, respectively, and 94.9% of ordered pharmacologic prophylaxis doses were administered. The incidence of 6-week post-partum VTE was 0.49%. There were no cases of VTE-associated mortality. Conclusion This study demonstrated that a large population of c-section patients fit the SMI criteria for pharmacologic VTE prophylaxis but did not receive it. We observed a 0.49% rate of VTE, which was slightly higher than the nationally reported average rate of 0.3%. With growing rates of pregnancy-associated VTE in the United States, perhaps a more aggressive guideline is warranted.


Cesarean section Maternal morbidity Obstetric thromboembolism Venous thromboembolism Venous thromboembolism prophylaxis United States 



The authors would like to thank Jana Avila of UC Davis Health for her data abstraction assistance.


No funding was received.

Conflicts of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Clinical PharmacyUniversity of California, San FranciscoSacramentoUSA
  2. 2.Department of Obstetrics and GynecologyDignity HealthElk GroveUSA
  3. 3.California Poison Control SystemUniversity of California, Davis Medical CenterSacramentoUSA
  4. 4.Department of PharmacyUniversity of California, San Diego HealthSan DiegoUSA
  5. 5.Department of Pharmacy ServicesUniversity of California, Davis Medical CenterSacramentoUSA
  6. 6.Department of Obstetrics and GynecologyUniversity of California, Davis Medical CenterSacramentoUSA

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