Abstract
BACKGROUND: Venous thromboembolism (VTE) is a significant contributor to maternal morbidity and mortality worldwide. Thromboprophylaxis guidelines are critical for VTE prevention, yet the optimal implementation of risk-appropriate thromboprophylaxis during pregnancy and postpartum remains uncertain. OBJECTIVE: To describe VTE risk assessment and thromboprophylaxis practices by medical practitioners in Obstetrics in a middle income setting as well as the barriers among obstetricians that may influence adherence to VTE guidelines. METHODS: An electronic survey was distributed to 120 medical practitioners at the University of the Witwatersrand, Johannesburg, South Africa to assess thromboprophylaxis practices in pregnancy and postpartum. RESULTS: Seventy (58%) responses were received, and 64 (53%) complete responses were analyzed. Most respondents practiced in the public sector (n = 53, 83%) and followed clinical guidelines, with 32 (50%) adhering to the Royal College of Obstetricians and Gynaecologists (RCOG) guideline. Low molecular weight heparin was widely prescribed during both antepartum and postpartum periods (n = 59, 92%), primarily at a fixed low-dose (n = 30/64, 47%). Barriers to the use of thromboprophylaxis included lack of mechanical prophylaxis (n = 19, 30%), perceived complications of thromboprophylaxis (n = 18, 28%), and cost (n = 14, 22%). Case-based assessments revealed significant variation in practices due to complex risk assessment scoring systems and disparate guideline recommendations. CONCLUSION: This survey provides insights into the practical issues affecting guideline and risk assessment tool implementation as well as challenges in a real-world clinical setting.