PREGNANCY-RELATED VENOUS THROMBOEMBOLISM: ASSESSMENT OF PREVALENT PERIOD, ASSOCIATED FACTORS, AND ITS OUTCOME IN ST. PAUL'S HOSPITAL MILLENNIUM MEDICAL COLLEGE

Abstract

Abstract Background: Pregnancy and the puerperium are well-established risk factors for deep vein thrombosis (DVT) and pulmonary embolism (PE), which are collectively referred to as venous thromboembolic disease (VTE). The need for thromboprophylaxis should be assessed antepartum, postpartum, and at any time the patient transitions from the outpatient to the inpatient setting. The clinical features of DVT in pregnancy overlap with many of the features of normal pregnancy. A high index of clinical suspicion and a low threshold for the use of objective confirmatory testing are required to accurately diagnose DVT during pregnancy. Method: A hospital-based descriptive cross-sectional study was conducted at SPHMMC from September 2017 to February 2021 by using a retrospective chart review of eligible pregnant and postpartum women with VTE having follow-up at the Hematology referral clinic. 84 pregnant and post-partum VTE patients were included, assessment of the prevalent period of VTE, associated factors, and its outcome was done. Results: The highest prevalent period for VTE was the post-partum period with 51 (60.7%) patients of which 27 (52.9%) modes of delivery were spontaneous vaginal delivery (SVD) and 24 (47.1%) were cesarean sections (C/S), with the day of stay after delivery 3-7 days 38 (74.5%). The most common VTE diagnosed was DVT alone 59 (70.2%), PTE alone 14 (16.7%) then CVT 6 (7.1%) and last is DVT with PTE 5 (6%). All the 64 DVT diagnoses are lower extremity 58 (90.6%) are left extremities while 6 are right extremities. From the 19 PTE diagnoses, 13(68.4%) are mild PTE. The most frequently identified medical history that the patient with VTE had is a history of hypertension 15 (83.3%). Other risk factor for VTE besides pregnancy the most frequently identified risk is preeclampsia 12 (66.7%). Out of 84 patients with VTE 67 (79.7%) completed their management with no complication related to the disease or management. Conclusions: From this study, the post-partum period which is within 6 weeks after delivery is the high likely prevalent time for VTE to occur and needs careful follow-up. And preeclampsia patients have a high chance to develop VTE as compare to other comorbid conditions. The outcome of VTE in pregnancy from this study is good with appropriate management using anticoagulants for a specific period.