Risk factors for bleeding complications of postoperative prophylactic anticoagulation therapy after cesarean section in preeclampsia cases

Abstract

Aim: This study aimed to identify risk factors for bleeding complications of postoperative prophylactic anticoagulation after cesarean section in preeclampsia cases. Methods: A total of 68 cases of preeclampsia or superimposed preeclampsia at a tertiary perinatal center in Tokyo between 2012 and 2017 were recruited for this study. Bleeding complications were defined as subcutaneous, subfascial, or intraperitoneal hematoma detected by ultrasonography or computed tomography. Associations of clinical and laboratory data with bleeding complications were assessed by univariate and multivariate analyses. Results: Bleeding complications were recorded in nine cases: subcutaneous hematoma in four cases, subfascial hematoma in four cases, and intraperitoneal hematoma in one case. Univariate analysis revealed preoperative platelet count and 24-h urine protein level to be associated with bleeding complications. Moreover, multivariate logistic regression analysis revealed preoperative platelet count (odds ratio, 0.867; 95% confidential interval, 0.756-0.994; P = 0.04) and 24-h urine protein level (odds ratio, 1.498; 95% confidential interval, 1.031-2.176; P = 0.03) to be independent risk factors for bleeding complications. Conclusion: Preoperative platelet count and 24-h urine protein level may help to identify patients at increased risk for bleeding complications.Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a leading cause of maternal morbidity and mortality in Japan.1) Not only pregnancy itself, but other factors during pregnancy and postpartum increase the risk of VTE. Among these, cesarean section is one of the most important risk factors.2) In Japan, the incidences of DVT and PE after cesarean section are 0.04% and 0.06%, respectively, and cesarean section increases the risk of developing DVT and PE by 5-and 22-fold, respectively.2,3) As cesarean section has become more common in Japan, preventing VTE after the procedure is becoming all the more important.Preeclampsia, a clinical entity included in hypertensive disorders of pregnancy (HDP), is characterized by hypertension, proteinuria, and multiple organ complications. Although the exact pathogenesis of preeclampsia is still unknown, it is thought to involve endothelial dysfunction resulting from an imbalance of pro-angiogenic and anti-angiogenic factors.4) As maternal endothelial damage activates the coagulation system, cesarean section in preeclampsia may increase the risk of VTE. 5) Consideration of prophylactic anticoagulation therapy for women with preeclampsia after cesarean section is recommended by the guidelines of the Japan Society of Obstetrics and Gynecology (JSOG) and 1 Hypertension Research in Pregnancy