Selective prophylaxis with gastric antacids. Identifying high risk parturients and auditing selective H2 receptor antagonist administration

A clinical study was conducted in the delivery ward to ascertain whether parturients at high risk for operative intervention could be identified and whether selective H2 receptor antagonist administration could be instituted. A high risk group comprising 25 per cent of patients with a tenfold increase of surgical intervention, could be identified. In practice, H receptor antagonists were not always given to these patients despite clear guidelines. The remaining 75 per cent of patients formed a low risk group with only 3 5 per cent requiring surgery. Despite the low rate of surgical intervention this group accounted for the largest number of patients not receiving oral ranitidine before surgery in the first year of the study. In the second year, there was improvement in the system and its application (P<00001). This trial illustrates some of the problems encountered when trying to implement a selective prophylactic regimen.