What is vte risk in pregnancy

Skip directly to site content Skip directly to page options Skip directly to A-Z link. Venous Thromboembolism Blood Clots. Section Navigation. Facebook Twitter LinkedIn Syndicate. Venous Thromboembolism Blood Clots and Pregnancy. Minus Related Pages. Expecting or recently had a baby? Planning a Pregnancy or Expecting a Baby?

Campaign Infographic and Factsheet These documents share important information about blood clot signs and symptoms, and risks for blood clots in pregnant women or women who just delivered a baby. Alabbad, Rowida A. Albassam, Rawan M. Alarfaj, Abdul Rehman Z. Pregnancy is one of the major risk factors for the development of venous thromboembolism VTE. To elucidate the circumstances surrounding pregnancy-induced deep vein thrombosis DVT and pulmonary embolism PE , assess potential factors triggering thrombosis e.

A retrospective chart review of patients with objectively confirmed VTE DVT, PE, or both that occurred during pregnancy, or the postpartum period was conducted. All patients who experienced episodes of objectively confirmed VTE were included. Overall, patients were included. Cesarean section was the most prevalent risk factor among study participants The most common clinical presentations were lower leg pain Pregnancy was the most common provoking factor for VTE in our study.

Pregnant women should undergo formal, written assessments of risk factors for VTE at the first visit and delivery. Larger studies with a randomized design, and control groups are required to confirm the current findings. Pregnancy is one of the major risk factors in the development of venous thromboembolism VTE. The risks of VTE during pregnancy and the postpartum period are increased approximately five- and fold, respectively [ 1 ].

The actual incidence of VTE among pregnant women may be overestimated if the diagnosis is based on a clinical evaluation only. This amounts to a 5—10 times higher rate than that observed in nonpregnant women [ 2 ]. The risk of thrombosis during pregnancy is attributed to homeostatic changes that occur during this period. During normal pregnancy, the concentrations of the clotting factors fibrinogen, VII, VIII, von Willebrand factor, IX, X, and XII are all increased, resulting in a hypercoagulable state, which exposes pregnant women to an increased risk of thrombosis [ 4 ].

Moreover, the mechanical obstruction by the growing uterus compromises venous outflow and subsequently increases the susceptibility of pregnant and postpartum women for developing thromboembolisms [ 5 ]. Moreover, pregnancy combined with either heritable or acquired forms of thrombophilia constitutes a cumulative risk of thrombosis [ 6 ]. The present study was conducted in a single hospital in Riyadh to address the lack of research data on pregnancy-induced thrombosis in Saudi Arabia, analyze the circumstances surrounding cases of pregnancy-induced VTE DVT and PE , identify potential factors triggering thrombosis i.

A retrospective chart review was conducted for all objectively confirmed VTE patients i. All patients who experienced one or more episodes of objectively confirmed VTE during pregnancy or postpartum period were included in this study. Patients with unusual site thrombosis i. The following demographic data were collected for analysis: age, weight, height, body mass index BMI , family history of VTE, previous history of oral contraceptive use, and the pregnancy trimester at the time of VTE diagnosis.

Patients were categorized based on their pregnancy status antenatal or postnatal , VTE, and trimester of pregnancy. Depending on their VTE diagnosis, patients were allocated to one of three cohort groups i.

Diagnoses were objectively confirmed by Doppler ultrasound in cases with DVT and with a ventilation-perfusion scan or computed tomography pulmonary angiography scan in cases with PE. The analysis consisted of descriptive group parameters. Continuous variables were processed as. Categorical variables were analyzed as frequencies with corresponding percentages within the different categories.

During the study period, VTE cases were identified. Patient demographic data revealed a mean age of years and a BMI of.

VTE cases were almost equally distributed, with a slight surge toward the first and third trimester Regarding the DVT sites, our results showed that among the patients with DVT, the left leg was involved in Right leg DVT was observed in The patients with VTE showed varying clinical presentations, among which the most common were lower leg pain, lower limb swelling, and entire leg swelling Cesarean section was the topmost prevalent risk factor among study participants, which was observed in 86 Risk factors that were less frequent include surgical procedures 3 1.

All thrombophilia investigations were performed after treatment completion and after 6 weeks of delivery Table 3. Among the antenatal patients , most patients 67 Among those who received LMWH, almost all patients 65 out of 67 received enoxaparin. We have thereby begun to understand the occurrence of and risk factors for pregnancy-associated VTE in our country, and possess a solid foundation to pursue future studies where we will revise and evaluate the risk-assessment tool from the RCOG.

Pregnancy and puerperal VTE constitute one of the major causes of maternal mortality. The incidence of VTE during pregnancy has been reported to be 0. Based on these risk factors, appropriate treatments with low-molecular-weight heparin have been administered for thrombosis prophylaxis, which has significantly decreased the maternal death rate caused by VTE.

Based on a large number of observational studies with reference to data from non-pregnant women, RCOG proposed a VTE risk-assessment-scoring tool during pregnancy and the puerperal periods, with different scores corresponding to different degrees of risk.

Women in different pregnancy and puerperal periods should therefore receive corresponding prophylaxis and treatment in order to decrease the incidence of VTE. ACOG specifically recommended that a mechanical pneumatic pump be used at both lower extremities during cesarean section to decrease the incidence of puerperal VTE. Asian countries have also conducted studies on pregnancy-associated VTE.

Genetic risk factors—such as antithrombin deficiency, factor V Leiden mutation, and the prothrombin gene GA mutation—in Asian populations were significantly lower than in western countries [ 15 ]; however, the incidence of VTE is basically the same as in developed countries.

In , the International GTH released an expert consensus on the diagnosis and treatment of pregnancy-associated VTE that summarized a large body of evidence proposing a series of protocols to diagnose and treat VTE during pregnancy [ 8 , 20 ]. In more developed countries, pregnancy-associated VTE is the leading cause of death for pregnant women, while in China, a less-developed country, the leading cause of death during pregnancy is still puerperal hemorrhage.

Pregnancy-associated VTE has therefore not received widespread attention from Chinese medical institutions and healthcare providers, although the Chinese Medical Association and Surgical Association have published the third edition of the guidelines for the diagnosis and treatment of DVT. The Chinese Academy of Obstetrics and Gynecology released an expert consensus on the development of DVT and prevention of PE after gynecologic operations in ; however, there was no risk assessment or prevention guidelines on pregnancy-associated VTE.

Due to the physiologic changes during pregnancy and puerperal periods, guidelines on non-pregnancy-related VTE cannot be directly applied to pregnant women.

Moreover, it is not known whether the VTE risk-assessment tool developed in western countries is suitable for the Chinese population. Low-molecular-weight heparin is relatively safe as a preventive medication for maternal DVT, but whether it is appropriate for use in high-risk Chinese patients is also unclear. Therefore, it is imperative that studies based on the Chinese population establish a VTE risk-assessment tool that can provide evidence-based guidelines to prevent and treat pregnancy-associated VTE.

The strengths and limitations of our proposed study are as follows. The first strength is that this is the first cohort study focusing on pregnancy-associated VTE in the Chinese population in Beijing. A second strength is in the innovation in this study in terms of its understanding of the prevalence of pregnancy-associated VTE in China, and the development of a pregnancy-associated VTE risk-assessment tool suitable for the Chinese population.

This tool will provide evidence-based guidelines to prevent, diagnose, and treat pregnancy-associated VTE. One limitation of our proposed study is that China has a vast territory, and this study is a single-centered study where the results may not represent the entire Chinese population.

Therefore, it will be necessary to conduct a multi-center research study with a larger sample size in the future. Data sharing is not applicable to this article as no datasets were generated or analyzed during the current proposal.

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