Hospital Variation and Associated Organizational Factors of Pregnancy-Related Venous Thromboembolism in China

Zhou, Qiongjie; Zhao, Zhekun; Xu, Jinghui; Xiong, Yu; Li, Xiaotian

doi:10.1177/10760296221076148

Cited by 3 publications

(2 citation statements)

References 23 publications

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“…VTE in the female demographic manifests at a youthful age of 40 in 50% of cases, with 20% of these cases linked to pregnancy, as per data from the RIETE [ 3 ]. Survey findings suggest that the incidence of pregnancy-related VTE in China, the United Kingdom, and the United States is 0.068%, 0.107%, and 0.066%, respectively [ 4 – 6 ]. Currently, thrombosis and thromboembolism stand as the primary causes of maternal morbidity and mortality [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Is early bilateral compression ultrasonography and D-dimer monitoring appropriately for prophylaxis and diagnosis of deep venous thrombosis after cesarean section women: a single-center observation study of Chinese Han population

Chen,

Jiang,

Zhou

et al. 2024

BMC Pregnancy Childbirth

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Background Venous thromboembolism (VTE) is most prevalent among parturients following a cesarean section (CS). The objective of this study was to assess the practical utility of bilateral compression ultrasonography (CUS) of the lower limbs, coupled with D-dimer monitoring, in the early diagnosis of VTE within the Han Chinese population. Methods Our prospective observational study included 742 women who underwent CUS and D-dimer testing on the first day post-CS. Subsequently, telephone or outpatient follow-ups were conducted until 42 days postpartum. States of hypercoagulation and thrombosis, as indicated by CUS, were classified as CUS abnormal. A D-dimer level ≥ 3 mg/l was considered the D-dimer warning value. Early ambulation and mechanical prophylaxis were universally recommended for all parturients post-CS. A sequential diagnostic strategy, based on the 2015 RCOG VTE risk-assessment tool, was employed. Therapeutic doses of low-molecular-weight heparin (LMWH) were administered for the treatment of thromboembolic disease. Prophylactic doses of LMWH were given for VTE prophylaxis in parturients with hypercoagulative status accompanied by D-dimer levels ≥ 3 mg/l. All high-risk women (RCOG score ≥ 4 points) were additionally treated with preventive LMWH. Statistical analyses were conducted using the R statistical software, with a two-sided P value < 0.05 considered statistically significant. Results Fifteen cases of VTE and 727 instances without VTE were observed. The overall VTE rate post-CS was 2.02% (15/742), with 66.7% (10/15) being asymptomatic. Eleven patients received a VTE diagnosis on the first postpartum day. Among the 41 parturients exhibiting hypercoagulation ultrasound findings and D-dimer levels ≥ 3 mg/l, despite receiving pharmacological VTE prophylaxis with LMWH, 4.88% (2/41) in the high-risk group were eventually diagnosed with VTE. A total of 30.86% (229/742) exhibited normal ultrasound findings and D-dimer levels < 3 mg/l on the first day post-CS, with no VTE occurrences in the postpartum follow-up. According to RCOG’s recommendation, 78.03% (579/742) of cesarean delivery women should receive prophylactic anticoagulation, while only 20.62% (153/742) met our criterion for prophylactic anticoagulation. Conclusion The strategy of timely routine bilateral CUS and D-dimer monitoring is conducive to the early diagnosis and treatment of VTE, significantly reducing the use of LMWH in the Chinese Han population.

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Section: Introductionmentioning

confidence: 99%

Is early bilateral compression ultrasonography and D-dimer monitoring appropriately for prophylaxis and diagnosis of deep venous thrombosis after cesarean section women: a single-center observation study of Chinese Han population

Chen,

Jiang,

Zhou

et al. 2024

BMC Pregnancy Childbirth

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“…Furthermore, the associations of specific periods of GWG with the category of VTE, PE, or DVT with or without PE have not been reported. In addition, few studies have examined trends in the incidence of pregnancy-related VTE in China, and these studies have shown variable results (15)(16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

Association Between Maternal Weight Gain in Different Periods of Pregnancy and the Risk of Venous Thromboembolism: A Retrospective Case–Control Study

Pei

et al. 2022

Front. Endocrinol.

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BackgroundVenous thromboembolism (VTE) remains an important cause of maternal deaths. Little is known about the associations of specific periods of gestational weight gain (GWG) with the category of VTE, pulmonary embolism (PE), or deep venous thrombosis (DVT) with or without PE.MethodsIn a retrospective case–control study conducted in Shanghai First Maternity and Infant Hospital from January 1, 2017 to September 30, 2021, cases of VTE within pregnancy or the first 6 postnatal weeks were identified. Controls without VTE were randomly selected from women giving birth on the same day as the cases, with 10 controls matched to each case. Total GWG and rates of early, mid, and late GWG values were standardized into z-scores, stratified by pre-pregnant body mass index (BMI). The adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated through multivariate logistic regression models.ResultsThere were 196 cases (14.4 per 10,000) of VTE within pregnancy or the first 6 postnatal weeks were identified. Higher total weight gain was associated with increased risks of PE (aOR, 13.22; 95% CI, 2.03–85.99) and VTE (OR, 10.49; 95% CI, 1.82–60.45) among women with underweight. In addition, higher total weight gain was associated with increased risk of PE (aOR, 2.06; 95% CI, 1.14–3.72) among women with healthy weight. Similarly, rate of higher early weight gain was associated with significantly increased risk for PE (aOR, 2.15; 95% CI, 1.05–4.42) among women with healthy BMI. The lower rate of late weight gain was associated with increased risks of PE (aOR, 7.30; 95% CI, 1.14–46.55) and VTE (OR, 7.54; 95% CI, 1.20–47.57) among women with underweight. No significant associations between maternal rate of mid GWG and increased risk for any category of VTE, PE, or DVT with or without PE were present, regardless of maternal pre-pregnant BMI.ConclusionThe GWG associations with the category of VTE, PE, or DVT with or without PE differ at different periods of pregnancy. In order to effectively improve maternal and child outcomes, intensive weight management that continues through pregnancy may be indispensable.

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Incidence of maternal venous thromboembolism in China: A systematic review and meta‐analysis

Luo

Shan

Zhang

et al. 2023

Intl J Gynecology & Obste

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BackgroundVenous thromboembolism (VTE) is one of the primary causes of maternal death. Although many studies have reported maternal VTE, no study has estimated the incidence of it in China.ObjectivesThe aim of this work was to estimate the incidence of maternal VTE in China and to compare the risk factors for it.Search strategyThe authors searched eight platforms and databases including PubMed, Embase, and Cochrane Library from inception to April 2022, with the search terms “venous thromboembolism” AND “puerperium (pregnancy)” AND “incidence” AND “China.”Selection criteriaStudies provide data to calculate the incidence of maternal VTE among Chinese patients.Data collection and analysisThe authors made a standardized table to collect data and calculated the incidence and 95% confidence intervals (CIs), founding source of heterogeneity by subgroup analysis and meta‐regression and judging publication bias by funnel plot and Egger test.Main resultsThe included 53 papers with a total sample size of 3 813 871 patients had 2539 cases of VTE, and the incidence of maternal VTE in China was 0.13% (95% CI, 0.11–0.16; P < 0.001).ConclusionsThe trend in the incidence of maternal VTE in China is stable. Cesarean section and advanced age are associated with a higher incidence of VTE.

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Hospital Variation and Associated Organizational Factors of Pregnancy-Related Venous Thromboembolism in China

Cited by 3 publications

References 23 publications

Is early bilateral compression ultrasonography and D-dimer monitoring appropriately for prophylaxis and diagnosis of deep venous thrombosis after cesarean section women: a single-center observation study of Chinese Han population

Is early bilateral compression ultrasonography and D-dimer monitoring appropriately for prophylaxis and diagnosis of deep venous thrombosis after cesarean section women: a single-center observation study of Chinese Han population

Association Between Maternal Weight Gain in Different Periods of Pregnancy and the Risk of Venous Thromboembolism: A Retrospective Case–Control Study

Incidence of maternal venous thromboembolism in China: A systematic review and meta‐analysis

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