Management of thromboprophylaxis during pregnancy among specialists in maternal-fetal medicine

OBJECTIVE: To evaluate practice patterns among maternal-fetal medicine physicians with regard to thromboprophylaxis in pregnancy. STUDY DESIGN: A Web-based survey was conducted among members of the Society for Maternal-Fetal Medicine (SMFM). The Web address for the survey and unique participant identification codes were mailed out to all SMFM members. Participants answered questions about their perceptions of risk factors for thrombosis in pregnancy as well as their use of thromboprophylaxis for cesarean section and for extended antepartum bed rest (> 72 hours). RESULTS: A total of 157 physicians responded to the survey. Few respondents use routine thromboprophylaxis for patients at cesarean section (8%) or who are on antepartum bed rest (25%), but the majority would use prophylaxis for patients at cesarean (91%) or during antepartum bed rest (81%) if these patients were considered to be at high risk for thrombosis. There was, however, great variation in the conditions thought to be risk factors for thrombosis, the risk factors of great enough risk to warrant prophylaxis and the prophylactic regimens used. CONCLUSION: Routine thromboprophylaxis for cesarean section or extended antepartum bed rest is uncommon. Although more common, risk-based thromboprophylaxis lacks a clear consensus as to which factors warrant this strategy and which regimen should be used.