Epidemiology of pregnancy‐associated pulmonary embolism in South Asian multi‐ethnic country: Mortality trends over the last four decades

Abstract

ObjectiveTo determine the cumulative incidence, time of occurrence and risk factors of pregnancy‐associated pulmonary embolism (PE) in Singapore, and to review the maternal mortality ratio of PE over the last four decades.Study design and settingIn this retrospective epidemiology review, women with pregnancy‐associated PE were identified via International Classification of Diseases codes and included if they had been objectively diagnosed on imaging with PE during pregnancy or within 6 weeks postpartum from 2004 to 2016 at KK Women's and Children's Hospital (KKH) and Singapore General Hospital (SGH) in Singapore. The medical records were reviewed and the time of occurrence of confirmed PE cases and risk factors for PE were noted.ResultsThere were 18 PE cases out of 174 708 deliveries, of which two were fatal, giving a cumulative incidence of PE at 1.03 per 10 000 deliveries and a mortality rate of 11.1%. The maternal mortality ratio is 1.14 per 100 000 deliveries, the lowest compared to that of the previous three decades (2.5–4.9 per 100 000 deliveries). Majority of PE (66.7%) occurred during the first 2 weeks postpartum. Cumulative incidence of postpartum PE was four times more in caesarean section compared to vaginal delivery at 1.58 per 10 000 deliveries and 0.40 per 10 000 deliveries, respectively.ConclusionAlthough the cumulative incidence of pregnancy‐associated PE in Singapore is low, it is comparable to the United Kingdom (UK) and United States (US). Risk assessment and thromboprophylaxis have decreased PE mortality significantly during this period.

Systemic Thrombolysis for Treatment of Acute Life-threatening Pulmonary Embolism During Cesarean Section Followed by Post-partum Rescue Hysterectomy: A Case Report and Review of the Literature

“…Resistance to APC occurs in up to 60% of pregnancies and is an established risk factor for venous thromboembolism (19). Furthermore, she underwent CS, which quadruples the incidence of postpartum PE compared to vaginal delivery (4), while advanced maternal age increased further this risk (2,4,15).…”

Reducing fetal radiation dose in computed tomography for pregnant patients: A literature review

“…The incidence of pulmonary embolism in pregnant patients is 5-12 per 10,000 pregnancies [42]. An epidemiological study in a South Asian multi-ethnic country showed that the incidence of this disease was 18 cases per 174,708 pregnant patients [43]. The algorithm of imaging procedures for diagnosis of pulmonary embolism during pregnancy has been illustrated in figure 1.…”

Pulmonary Embolism After in vitro Fertilization and Cesarean Section: Two Case Reports and Brief Review of the Literature

“… 7 Apart from that, there may be more risk factors that we can discuss in these two highly similar cases: the two cases had assisted reproductive techniques (ART) or in vitro fertilization (IVF) process in common, studies have shown that IVF is maternal risk factors for PE in pregnancy; 8 Cesarean section is a traditional surgery; PE-related morbidity and mortality are particularly high in cesarean section; some studies have pointed out that the cumulative incidence of PE after cesarean section is higher than that after vaginal delivery. 9 Besides, it was found that the common symptoms of PE overlap with the typical symptoms such as shortness of breath and edema in normal pregnancy, 10 and plasma D-dimer levels are elevated physiologically during this period, which is not necessarily related to thromboembolic complications. 11 , 12 The imaging examination plays a diagnostic role, which has many limitations in the special period of pregnancy, making it difficult for pregnant women to diagnose PE.…”