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.