Background: Expert opinion varies on the use of therapeutic unfractionated heparin during the peripartum period. While dosing guidelines have been suggested, their transition to clinical practice is lagging. Aim: To evaluate the protocols employed, adherence to these protocols, and monitoring of therapeutic unfractionated heparin in obstetric patients during the peripartum period in a quaternary teaching hospital. Method: This retrospective study investigated all women who received therapeutic heparin during the peripartum period between June 2014 and June 2016. The peripartum period was defined as 28 days prior to and post-delivery. Prescribing and administration information was obtained from the state-wide heparin infusion order form. Medical notes were studied to document the heparin infusion protocols utilised. Results: A variety of dosing approaches were used in the 20 patients studied. Heparin bolus dosing was correctly determined in 46% of results. Heparin infusion rate change was correctly determined in 64% of results. The activated partial thromboplastin time (APTT) was correctly ordered by the medical officer in 230 results (66%), incorrectly ordered in 68 results (20%) and unable to make an interpretation in 48 results (14%). There were no cases of rethrombosis reported. Post-partum bleeding occurred in two patients. The APTT at the time of these bleeding events was noted to be subtherapeutic. Conclusion: This study highlights the variability in therapeutic heparin protocols utilised during the peripartum period. The desire by clinicians to target a low APTT range during the postnatal peripartum period to balance bleeding risk has also been identified in this study.

The care of the extremely premature neonate involves numerous medication related challenges. This case not only demonstrates the specialist knowledge, skills and attitudes required by a pharmacist working in this complex field but the impact that can be achieved working closely with the neonatal team.

BackgroundTherapeutic anticoagulation may be required during pregnancy to treat venous thromboembolism (VTE), for patients considered at high risk of thrombosis and for the management of mechanical heart valves (MHVs). Prescribing of therapeutic anticoagulation during the postnatal peripartum period is complicated by managing the risk of postpartum haemorrhage. Currently, there are no standardised protocols for the use of therapeutic heparin in this setting and no randomised control trials have been undertaken to evaluate best practice.AimUsing survey techniques, this study aimed to establish current practice in Australia and New Zealand regarding the use of therapeutic anticoagulation during the postnatal peripartum period.MethodsThe survey consisted of 36 questions and was made available using the electronic Internet platform Survey Monkey.ResultsFor patients at low risk of rethrombosis, 91% and 78% of respondents would use low molecular weight heparin (LMWH) after standard vaginal delivery (SVD) and after caesarean section (CS), respectively, with the remaining respondents choosing to use unfractionated heparin (UFH). For patients at high risk of rethrombosis, 56% and 51% of respondents would use LMWH after SVD and CS, respectively, with the remaining respondents choosing to use UFH. For patients with MHVs, 29% and 26% of respondents would use LMWH after SVD and CS, respectively, with the remaining respondents choosing to use UFH.ConclusionAlthough this study included a relatively small cohort of respondents, the results do indicate trends among therapeutic anticoagulation in the postnatal peripartum period. Research regarding the most efficacious anticoagulation management would help clinicians develop evidence‐based protocols to guide best practice.

Therapeutic heparin during the peripartum periodchallenges associated with safe use.