Can we identify risk factors during pregnancy for thrombo-embolic events during the puerperium and later in life?

Abstract

Objectives: To investigate parturients at risk to develop venous thrombo-embolic events (VTE) in the puerperium or later in life, during a follow-up of more than a decade and compare risk factors for VTE during the puerperium with VTE later in life.

Methods: A nested case–control study was conducted to profile parturients at risk for VTE and a secondary analysis to compare risk factors for VTE during or after puerperium. We used a cohort of 95 257 women who gave birth between the years 1988 and 1998.

Results: Independent risk factors to develop VTE were peripartum hysterectomy, stillbirth, cesarean delivery (CD), obesity, pregnancy-related hypertension, grandmultiparity and advanced maternal age. Women undergoing CD and those receiving blood transfusion were more likely to develop early versus late VTE (OR = 2.0, 95% CI = 1.15–3.5 and OR = 11.0, 95% CI = 2.25–55.5; respectively). Patients that encountered VTE during the puerperium had more pulmonary emboli and less deep vein thrombosis, compared with the late VTE group (p < 0.001).

Conclusions: Maternal age, grandmultiparity, pregnancy-related hypertension, CD, obesity, stillbirth and peripartum hysterectomy are independent risk factors for the development of VTE. CD and blood transfusion were predictive of early versus late VTE.

• Pregnancy
• puerperium
• risk factors
• thrombo-embolic events

Declaration of interest

The authors report no conflict of interest. The authors alone are responsible for the content and writing of this article.

This work was presented, in part, at the 33th meeting of the Society of Maternal and Fetal Medicine (SMFM), San-Francisco, CA, USA, 10–16 February 2013.