Survey of the use of anticoagulation and anesthesia during cesarean section in patients with severe Pregnancy induced Hypertension (PIH) between 2010 and 2011 in Japan

Aim: A survey of anticoagulation and anesthesia during cesarean section in patients with severe pregnancy induced hypertension (PIH) in Japan was conducted by a committee of the Japan Society for the Study of Hypertension in Pregnancy (JSSHP) to investigate 1) prophylactic anticoagulation for venous thromboembolism (VTE) after cesarean section in patients with PIH and 2) heparin treatment for disseminated intravascular coagulation (DIC) in patients with PIH and related disorders. Methods: Surveys including questionnaires for obstetricians and anesthesiologists were separately conducted among 127 eligible regional leading institutes and hospitals of maternal-fetal medicine with neonatal intensive care units (NICUs) throughout Japan in order to analyze the participants' perspectives on anticoagulation for VTE and DIC in patients with PIH and related disorders. Results: Sixty-six (52.2%) of the 127 eligible institutes and hospitals ultimately responded. Prophylactic anticoagulation after cesarean section was administered in 82% of the hospitals for patients without PIH to prevent various risks. However, the dose of prophylactic anticoagulation for VTE after cesarean section was not optimized for each patient with PIH in 73% of the hospitals. Anesthesiologists at approximately 74% of the hospitals used neuraxial regional anesthesia in patients with PIH who underwent cesarean section. They selected general anesthesia rather than regional anesthesia if they judged the effects of anticoagulation to be greater than the level indicated for regional anesthesia remaining during surgery. Approximately 30% of the hospitals used anticoagulants, including heparin and / or antithrombin, at the onset of DIC for prophylaxis of VTE after cesarean section in patients with PIH. Conclusions: Most recommendations, worldwide as well as in Japan, in guidelines for prophylactic anticoagulation during cesarean section are based on observational studies and lack statements or recommendations on the use of anesthesia and appropriate anticoagulation during cesarean section in patients with PIH. The JSSHP needs to be encouraged to design studies to obtain better evidence for the use of anticoagulation in patients with severe PIH and to publish a clinical practice bulletin as soon as possible.