Obstetric venous thromboembolism: a one-year prospective study in a tertiary hospital in Egypt

Abstract

Background and objective

Obstetric venous thromboembolism (VTE) poses a life-threating burden and it is one of the major causes of maternal morbidity and mortality with an increased incidence throughout the last decades. The objectives of this study were to assess the incidence of VTE, types of prophylaxis received, and factors determining prophylaxis in women at VTE risk during pregnancy and puerperium at a tertiary hospital for 1 year.

Methods

This is a prospective study that was carried out at Minia maternity university hospital, Egypt during the period from June 2018 to June 2019. The study included women attended the hospital at risk of VTE as per the RCOG guidelines. Full history, patient characteristics, and VTE risk factors were assessed.

Results

During the study period, a total of 901 women attended the hospital and perceived at risk of VTE (298 cases during pregnancy and 603 cases during puerperium), about half of them were mild in intensity. They comprise 8.22% of the total deliveries during the study period (n = 10,956). About two-thirds of them (71.5%) had a cesarean delivery. Varicose veins were found in 209 cases (23.2%), previous VTE in 189 cases (21.0%), previous superficial vein thrombosis was recorded in 240 cases (26.6%) and previous arterial ischemic events in 83 cases (9.2%). The vast majority of patients (99.6%) received the pharmacological type of prophylaxis (55.6% of them received unfractionated heparin and the rest of them 43.9% received Aspirin). Only six cases developed VTE from the total included cases with an incidence of 0.55/1000 maternities (0.055%). Obesity (BMI >30 kg/m²) and cesarean delivery were significant factors that determine VTE prophylaxis with an odds ratio of 1.68 (95% CI, 1.20–2.35, p < .01) and 2.05 (95% CI, 1.49–2.80, p < .01), respectively.

Conclusion

The incidence of women perceived at VTE risk was 8.22%, about half of them were mild in intensity. The risk of VTE was higher during the postpartum period than that during pregnancy. The incidence of VTE was 0.55/1000 overall maternities (0.055%). The pharmacological type of prophylaxis was the predominant used type. Obesity and cesarean delivery were significant factors determining VTE prophylaxis.

Keywords:

• Obstetric
• venous thromboembolism
• incidence
• prophylaxis

Acknowledgements

We acknowledge all participants included in this investigation, besides the clinical staff members of Obstetrics & Gynecology department, Minia University hospital, who were involved for the completion of the study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This project was locally funded from El-Minia University.