- Describe your topic.
- Issue: Despite recent strategies and recommendations from a variety of professional organizations that are aimed at reducing the incidence of VTE in the United States, the rate continues to rise. One critical gap is the lack of standardized, validated maternal risk assessment tools that can facilitate early identification of women at risk for this life threatening pregnancy related complication. Population: All pregnant and postpartum women are at risk for VTE. It is commonly known in obstetrics that the physiologic and anatomic changes occurring during pregnancy place these women at risk for the following reasons: • Pregnancy is a hypercoagulable state due to alterations in clotting factors that result in increased risk for clot formation or decreased ability for clots to dissolve. • Venous stasis results from the weight of the growing uterus on the great vessels, and influence of pregnancy hormones that increase vessel wall distensibility and reduce blood flow. • Vessel wall injury can result from the stress of vessel wall stretching or hypertension. Strategy: AWHONN is interested in developing a standardized and validate risk assessment scoring tool that can facilitate identification of women at risk, and that can guide further clinical evaluation and treatment. Outcomes: Development and implementation of a standardized VTE risk assessment tool specifically designed for pregnant and postpartum women will result in more timely identification of women at risk for VTE. Once the level of risk is identified, interventions targeted to preventing life threatening clot formation can be implemented.
- Describe why this topic is important.
- Maternal mortality in the United States continues to rise despite all of the currently available medical technologies and therapeutic modalities. Significantly, more than 60% of all maternal deaths occur during the first year following the birth of the baby (Creanga et al., 2015). Venous thromboembolism (VTE) in pregnancy is one of the most significant causes of maternal morbidity and mortality in the United States; but this pregnancy complication is also one of the most preventable causes of maternal death in the country (CDC, 2017). Centers for Disease Control and Prevention (2017). Pregnancy Mortality Surveillance System. Retrieved from https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pmss.html Creanga, A. A., Berg, C. J., Syverson, C., Seed, K., Bruce, F. C., & Callaghan, W. M. (2015). Pregnancy-related mortality in the United States, 2006–2010. Obstetrics and Gynecology, 125(1), 5–12. doi: 10.1097/AOG.0000000000000564
- Tell us why you are suggesting this topic.
- There is no universally accepted or validated VTE risk assessment tool for pregnant women in the United States. Consequently, the assessment of VTE risk and application of prevention protocols is underutilized in both inpatient and outpatient settings. The goal of VTE risk assessment is to identify obstetric and non-obstetric medical, genetic, and lifestyle factors that place pregnant and postpartum women at risk, and to guide care planning for VTE prevention based on a standardized risk scoring framework. Thorough risk assessment conducted at intervals during pregnancy and the postpartum period to identify expected or unexpected events that can change risk status is an ideal method to prevent VTE. Therefore, risk assessment should routinely occur during the preconception, prenatal, intrapartum and postpartum periods; and with any change in maternal status that warrants additional evaluation.
- Target Date.
- Describe what you are doing currently and what you are hoping will change because of a new evidence report.
- AWHONN has published a variety of evidence-based education and practice resources about VTE in pregnancy that include recommendations from professional and government organizations including the American College of Obstetricians and Gynecologists (ACOG), the American College of Chest Physicians (ACCP) and the Centers for Disease Control and Prevention (CDC). Each of these organizations presents different protocols and recommendations for identification, prevention, and treatment of VTE. These variations can lead to inconsistencies and confusion among clinicians about best practice and course of action for risk identification, prevention and treatment. AWHONN’s goal is to be a leader in addressing the risk assessment component of VTE management to ensure that all pregnant women are evaluated in the same manner by nurses and physicians alike, regardless of the patient care setting.
- How will you or your group use the information from a new evidence report?
- At a minimum, the evidence report will inform AWHONN about current literature related to VTE and VTE risk assessment and prevention in the obstetric population. As a result of the evidence report, AHRQ will have facilitated a major first step for AWHONN toward establishing one, standardized, valid risk assessment tool that can be ultimately used by all clinicians caring for pregnant and postpartum women. With this report, AWHONN will be better positioned to seek the resources necessary to develop and test a standardized tool.
- How would you or your group plan to disseminate information from the report? Who would you plan to disseminate it to?
- The report will primarily be used to inform our internal and external AWHONN stakeholders about the feasibility of moving forward with risk assessment tool development. The report may also be used to update current evidence-based resources and/or create new content.
- Do you know of organizations that could use an evidence report to change clinical practice? Are you a part of, or have you been in contact with, any organizations that might implement the research findings of an evidence report?
- Not at this time.
- Information About You: (optional)
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- Provide a description of your role or perspective.
- Nurse Progam Development Specialist with a focus on evidence-based guideline development
- If you are you making a suggestion on behalf of an organization, please state the name of the organization.
- Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN)
- Please tell us how you heard about the Effective Health Care Program.
- Email from AHRQ to Anne Santa-Donato, MSN, RNC at AWHONN
