Rate and Risk Profile of Deep Venous Thrombosis in
Pregnancy and Postpartum Period Among Sudanese
Women
Abstract
Background: Deep venous thrombosis (DVT) during pregnancy is associated with high mortality, morbidity, and costs. DVT can also result in long-term complications that include post thrombotic syndrome (PTS) adding to its morbidity.
Objective: To determine rate, timing and risk profile of deep venous thrombosis during pregnancy and puerperium among Sudanese women.
Methodology: It was prospective case control and hospital-based study carried out at Shendi Teaching and Elmec-Nimir University Hospitals -Sudan from March 2017 to March 2018. Seventy-eight pregnant women or in puerperium with Doppler confirmed deep venous thrombosis were enrolled in the study, representing the main study group, while another 156 pregnant women without DVT were selected as the control group.
Results: The current study showed the frequency of DVT was (0.622%), 78 out of 12,542 deliveries during the whole study period, with (0.176%) and (0.446%) occurring antenatal and postnatal respectively. The rate was 622 DVT per 100,000 births. This study revealed that women who are primigravida, had positive family history of VTE, had past history of DVT, had Anti phospholipids, anemia and delivered by C/S showed statistically significant association with DVT.
Conclusions: The prevalence of DVT in our study was 622 per 100 000 births per year in pregnant and postpartum women. There is an urgent need for prophylaxis measures against DVT for pregnant women who found at higher risk for DVT.
Keywords: Deep Venous thrombosis; Pregnancy; Postpartum; Rate; Risk profile; Sudanese women
Introduction
Venous thromboembolism is a leading cause of maternal death in developed and developing world. Venous thromboembolism can occur throughout pregnancy with an estimated antenatal and postnatal incidence of 6-12 and 3-7 per10, 000 maternities respectively. Over 40% of antenatal venous thromboembolism occurs in the first trimester of pregnancy [1].
The daily risk of venous thromboembolism is four-fold higher in post-natal period compared with antenatal period [2]. The factors which increase the risk of venous thromboembolism in pregnant and postnatal women are age more than 35, prime party, pre-eclampsia, varicose veins, obesity, cesarean section, previous VTE, family history of VTE , patients with inherited thrombophilias, excessive blood loss, long haul travel, prolonged labor, instrumental delivery and immobility after delivery [3].
Clinical diagnosis of deep venous thrombosis by, leg pain, swelling, tenderness, high temperature, oedema, lower abdominal pain and high total white blood cell count. It may also present with features of pulmonary embolism; dyspnea, chest pain, collapse, haemoptesis, fainting and increased jugular venous pressure [4].
Compression duplex ultrasound of the entire proximal venous system is considered the optimal first-line diagnostic test for DVT in pregnancy [5,6]. An apparently normal ultrasound examination in a patient with significant symptoms and signs or risk factors for VTE does not exclude a calf DVT, so serial ultrasound examinations should be repeated [7,8]. When iliac vein thrombosis is suspected because the woman reports back pain and swelling of the entire limb, pulsed Doppler, magnetic resonance venography, or conventional contrast venography should be considered [9,10]. This study attempts to determine rate, timing and risk profile of deep venous thrombosis during pregnancy and puerperium. among Sudanese women.
Materials and Methods
It was prospective case control and hospital-based study carried out at Shendi Teaching and Elmec-Nimir University Hospitals -Sudan from March 2017 to March 2018. Seventy eight pregnant women or in puerperium who presented with symptoms suggestive of DVT and Doppler confirmed deep venous thrombosis were enrolled in the study, representing the main study group, while another 156 pregnant women from the population of patients presenting to the same hospitals without symptoms of VTE were selected as the control group. Participants completed a questionnaire on personal data and clinical history. Questions regarding known risk factors for DVT such as age, parity, mode of delivery, family history or past history of VTE, medical disease history, personal history of antiphospholipid, sickle disease and thrombophilia. BMI was calculated which defined as the weight in kilograms divided by the square of the height in meters (kg/m2). The BMI was determined by using World Health Organization (WHO) classification for obesity.
Statistical analysis was performed via SPSS software (SPSS, Chicago, IL, USA). Continuous variables were compared using student’s t test (for paired data) or Mann–Whitney U test for nonparametric data. For categorical data, comparison was done using Chi-square test (χ²) or Fisher’s Exact test when appropriate. A P value of <0.05 was considered statistically significant.
Ethical clearance and approval for conducting this research was obtained from the general manager of the hospitals and informed written consent was obtained from every respondent who agreed to participate in the study. The respondents informed that the study is not associated with experimental or therapeutic intervention while information was collected from them.
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