O&G Cases · Antenatal care — medical disorders in pregnancy
Post-caesarean thromboprophylaxis in a high-BMI woman — prescribing and counselling station
Prescribing and counselling station: post-caesarean thromboprophylaxis for a high-risk, high-BMI woman with a previous VTE. Tests the candidate's ability to risk-tier, prescribe weight-based enoxaparin with the Bruno trial evidence, plan the 6-week postpartum course, and counsel on safety and injection technique. Includes assessor key and marking domains.
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Station brief
Format. Prescribing and counselling station, approximately 12 minutes. You are the obstetric registrar on the postnatal ward. The woman is 12 hours post-emergency caesarean, haemodynamically stable, haemostasis secure. The assessor will feed her questions and concerns. [1]
Candidate instruction. Risk-tier her, prescribe the postpartum thromboprophylaxis with the dose and duration, defend the dose with the trial evidence, and counsel her on safety, injection technique, and adherence. [1][3]
References5ShowHide
- [1]Bates SM, Rajasekhar A, Middeldorp S, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy Blood Adv, 2018.PMID 30482767
- [2]Bistervels IM, Buchmüller A, Wiegers HMG, et al. Intermediate-dose versus low-dose low-molecular-weight heparin in pregnant and post-partum women with a history of venous thromboembolism (Highlow study): an open-label, multicentre, randomised, controlled trial Lancet, 2022.PMID 36354038
- [3]Bruno AM, Allshouse AA, Campbell HM, et al. Weight-Based Compared With Fixed-Dose Enoxaparin Prophylaxis After Cesarean Delivery: A Randomized Controlled Trial Obstet Gynecol, 2022.PMID 36075079
- [4]American College of Obstetricians and Gynecologists' Committee on Practice Bulletins-Obstetrics ACOG Practice Bulletin No. 196: Thromboembolism in Pregnancy Obstet Gynecol, 2018.PMID 29939938
- [5]Greer IA, Nelson-Piercy C Low-molecular-weight heparins for thromboprophylaxis and treatment of venous thromboembolism in pregnancy: a systematic review of safety and efficacy Blood, 2005.PMID 15811953