Impact of Delivery-Related Factors on Venous Thromboembolism Risk During Labor [16L

Abstract

INTRODUCTION: Pregnancy is a risk factor for venous thromboembolism (VTE). Several VTE risk assessment models (RAM) have been created but not validated in obstetrics. It is unclear which factors confer greater risk of VTE and at what point VTE risk assessment should occur. Our goal was to determine which RAM is most effective at capturing high risk patients while excluding low risk patients and to determine how delivery-related factors (such as mode of delivery, blood loss, transfusion, length of stay) affect RAM scores. METHODS: IRB-approved cross-sectional study evaluating 507 deliveries during November 2018 at an urban academic center. 5 VTE cases were identified from 2013-2018. RAM scores (ACOG, CMQCC, ACCP, RCOG, Caprini, Padua) were calculated for all subjects at admission and discharge. Descriptive statistics and T-tests were utilized to investigate the relationships between mode of delivery, blood loss, blood transfusion, length of stay and RAM score. RESULTS: The Caprini score stratified 40% of VTE cases as high risk pre-delivery whereas 80% were high risk post-delivery. RCOG stratified 80% of cases as high risk pre-delivery and 100% post-delivery. ACCP stratified 80% of cases as high risk pre-delivery and 100% post-delivery. CMQCC stratified 0% of cases as high risk pre-delivery and 80% of cases post-delivery. Further analysis of Caprini, Padua, and RCOG scores demonstrated a significant association between postpartum hemorrhage and higher score. CONCLUSION: RCOG and ACCP models categorized most controls and cases as low- and high-risk, respectively. VTE assessment should be performed at hospitalization and prior to discharge because delivery-related factors affect risk of VTE.