Cesarean Delivery Places all Women at Risk for VTE, Perinatal Expert Says: Institute of Healthcare Improvement Webinar Examines Ways to Reduce Maternal Death Rate

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The Physician-Patient Alliance for Health & Safety participated in a January 22, 2014 webinar hosted by the Institute for Healthcare Improvement on the dangers all women who undergo cesarean delivery face.

Essentially every patient is in moderate risk

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All women who undergo cesarean delivery are at risk of venous thromboembolism (VTE), a disease that can lead to long-term complications and even death, a leading perinatal expert stated during a recent webinar hosted by the Institute of Healthcare Improvement (IHI).

“Essentially every patient is in moderate risk,” said Peter Cherouny, MD, Emeritus Professor, Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont and Chair and Lead Faculty of the IHI Perinatal Improvement Community “The only exceptions to that would be patients under age 40 who have no other risk factors and whose surgeries are less than 30 minutes.”

Dr. Cherouny added that while some cesarean surgeries are performed in less than 30 minutes, the clock for the procedure starts ticking the moment when anesthesia is administered. “If you take that into account, there is really no case of a patient in the low-risk category undergoing a cesarean section,” he said.

Joining Dr. Cherouny in the webinar, Michael Wong, Executive Director of the Physician-Patient Alliance for Health and Safety (PPAHS), pointed to research from the Centers for Disease Control and Prevention (CDC) that finds that the maternal death rate in the United States has more than doubled in the past 25 years.

The CDC research also shows that 21 deaths occurred for every 100,000 live births in 2010 in the U.S., which had one of the highest maternal death rates among the 50 nations studied, Mr. Wong said.

“This ranking is particularly alarming because the U.S. spends more money per capita for maternity care than any other country,” he said.

Concurring with Mr. Wong, Dr. Cherouny said that to lower maternal death rates and decrease incidences of VTE-related complications, “we really need to move back into the prevention phase.”

To that end, Dr. Cherouny recommended that “All patients having a cesarean delivery should have pneumatic compression devices placed prior to surgery.”

Pneumatic compression therapy -- such as fitting inflatable compression devices on a patient’s legs before cesarean delivery and using inflatable compression sleeves until the patient is able to walk after delivery – improves blood flow in the treated area, which reduces the opportunity for VTE to occur.

To help hospitals and healthcare providers address the VTE issue in their institutions, PPAHS, in collaboration with IHI and the National Perinatal Association (NPA), has created “Ob/Gyn VTE Safety Recommendations for the Prevention of VTE in Maternal Patients".

Compiled recently by a panel of health experts, the recommendations give providers a step-by-step checklist to help assess patient risk for VTE and identify the appropriate prophylaxis regimen to improve health outcomes for maternal patients.


The Physician-Patient Alliance for Health & Safety (PPAHS) is an advocacy group dedicated to improving patient health and safety. PPAHS seeks to advance key patient health and safety initiatives that significantly impact patient lives and to do so in a prescriptive and practical manner by endorsing and publicizing health expert opinion that is supported by healthcare organizations and medical societies, surveying healthcare professionals to determine current practices and using these responses to encourage improvement, sharing best practices to encourage their spread and adoption, developing safety checklists and recommendations, and advocating for the adoption of standards to help eliminate adverse events. For more information, please go to http://www.ppahs.org

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