Background: Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolisms (PE) continues to be a leading cause of maternal mortality (MM) in the United States. VTE accounts for roughly 9-10% of all maternal deaths. Other countries have adopted anticoagulation protocols to reduce MM rates, but the US has yet to follow suit. The American College of Obstetricians and Gynecologists (ACOG), the American College of Chest Physicians (CHEST), and the Royal College of Obstetricians and Gynaecologists (RCOG) all vary in their guidelines for thromboembolism prophylaxis. Patients who deliver by Cesarean section (C-section) have higher incidences of MM due to pulmonary embolism. Specifically for patients who undergo a C-section, ACOG recommends only mechanical compression devices along with a risk scoring system, which is not standardized across hospitals. Objective: Improve existing data regarding populations at risk for VTE consequences; Create a standard practice across the nation for anticoagulation in those with increased risk of MM due to VTE. Methods: Develop a QI project in order to establish a protocol and track outcomes. Perform a retrospective analysis of patients with these risk factors (listed below) within our Graduate Medical Education (GME) population to determine our pre-protocol VTE risk at Medical City Women’s Clinic. Create a protocol in which high-risk patients receive low molecular weight heparin (LMWH) for VTE prophylaxis. Track outcomes and compare VTE risk in this cohort compared to our population baseline Eventually expand to other institutions to improve the power of the study and MM rates amongst the general public in the United States. Risk Factors: Pre-eclampsia diagnosis Cesarean section Postpartum hemorrhage Postpartum infection such as endometritis BMI > 30 Personal history of thrombosis Multiple gestation Anticipated Results: We anticipate that with this protocol, patients will experience reduced rates of VTE consequences in the postpartum period. We also anticipate that with a strong enough study, our findings would allow us to make a case for standardized VTE prophylaxis guidelines by the American College of Obstetricians and Gynecologists (ACOG).

Cardiovascular Diseases
Diseases
Female Urogenital Diseases and Pregnancy Complications
Health and Medical Administration
Medical Specialties
Medicine and Health Sciences
Obstetrics and Gynecology
Quality Improvement