TITLE:
A Study on Risk Factors for Venous Thromboembolism and the Requirement of Thromboprophylaxis in Pregnancy and Postpartum Period in a Tertiary Care Centre in South Asian Country: A Cross Sectional Study
AUTHORS:
P. L. A. Sirisena, S. N. Samarakkody, B. Subhani, D. Gunawardana, M. A. K. Perera, C. Rathnayake
KEYWORDS:
Venous Thromboembolism, Postpartum, Thromboprophylaxis, Cross-Sectional Study, Maternal Morbidity and Mortality
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.13 No.3,
March
10,
2023
ABSTRACT: Introduction: Thrombosis is a major cause of maternal death
worldwide. During pregnancy, the risk of venous thromboembolism (VTE) increases
fourfold to five-fold and contributes towards maternal morbidity and mortality. Sri Lanka does not have a proper assessment tool to detect and manage it in the antenatal care. Objectives: To
identify risks factors for VTE among pregnant mothers, postpartum
mothers according to RCOG (Royal College of Obstetricians) risk categorization
and to assess the requirement of thromboprophylaxis. Method: A cross
sectional study was conducted at the antenatal clinics and obstetrics and
gynaecology wards (ward 2, 5, 8) of De Soysa Hospital for Women in 2021. Obstetric
thromboprophylaxis risk assessment tool recommended by the RCOG was used for
the risk assessment of pregnant mothers during the antenatal and postpartum
period. Results: In antenatal period, obesity (BMI > 35), age more
than 35 years and parity more than 3 were the commonest risk factors. Out of
404 mothers, 67.33% did not have any risk factors. Among
others, 18.56%, 0.40%, 2.72%, 0.99%
had a score of 1, 2, 3 and 4 respectively. Patients with intermediate (0.99%)
and high risk (2.72%) were commenced on thromboprophylaxis from 28 weeks. The
low-risk category was not started on any treatment (28.96%, n = 97). Approximately 96% of mothers did not require any
thromboprophylaxis during antenatal period. Another 404 postnatal mothers were
recruited for the study group. Elective caesarean section and caesarean section
during labour were the main risks identified other than pre-existing antenatal
risks. 39.95 % of mothers did not have any risk factors and 37.22% of mothers
had a score of 1. Conclusions: VTE risk assessment tool can be
implemented at national level to detect patients at risk of VTE and improve
maternal care.