Venous and Arterial Thrombosis during Pregnancy: Epidemiology

Abstract

Venous thromboembolism is an important cause of maternal morbidity and mortality throughout the developed world with an incidence of about 1 per 1000 deliveries, of which 1-2% are fatal. Two thirds of women who have a pregnancy-associated deep vein thrombosis develop the post-thrombotic syndrome and suffer long-term morbidity. The risk of venous thromboembolism is greater in older women and in women who have an operative delivery. Other risk factors include obesity, high parity, and immobilization. Acquired or inherited thrombophilias augment the risk, and some women with a previous history of venous thromboembolism may be at increased risk of a recurrence associated with pregnancy. Arterial thrombosis is uncommon in pregnancy but may have devastating consequences. The incidence of ischemic stroke associated with pregnancy is unknown but is estimated to be about 0.18 per 1000 deliveries-the majority being the result of arterial occlusion. Myocardial infarction is estimated to occur in 0.1 per 1000 women in association with pregnancy. Events occur most frequently peripartum or postpartum. Risk factors include maternal age, atherosclerosis, obesity, hypertension, and smoking.

Contraception for Adolescents

“…92,93 In comparison, the incidence of venous thromboembolism associated with pregnancy and postpartum is 10 to 20 per 10 000 womanyears, of which 1% to 2% are fatal. 94,95 Although smoking should be discouraged, it is not a contraindication to COC use in teenagers and adults younger than 35 years old. 37 Patients should be informed that common transient adverse effects of COCs include irregular bleeding, headache, and nausea.…”

Risk of Venous Thromboembolic Disease Associated With Hormonal Contraceptives and Hormone Replacement Therapy

“…In healthy women, VTEs are more frequent during pregnancy than during OCP use, with an estimated incidence of 1 case per 1000 deliveries and a 1% to 2% case-fatality rate. 133 In carriers of the factor V Leiden or prothrombin G20210A mutation, the pregnancyrelated VTE risk also seems to be exponentially increased. 134 HRT and VTEs 1.…”

Inclusion of Body Mass Index in the History of Present Illness

“…15,[23][24][25][26][27] As shown in Table 3, BMI had the strongest association (32 [94%]) with adverse pregnancy outcomes or conditions. [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] Most importantly, there was a dose-response relationship between increasing maternal BMI categories and outcomes with morbid obesity (BMI higher than 40) associated with increased rates of multiple adverse pregnancy outcomes such as fetuses large for gestational age (odds ratio [OR] 3.82), preeclampsia (OR 4.82), cesarean delivery (OR 2.69), antepartum stillbirth (OR 2.79), shoulder dystocia (OR 3.14), instrumental delivery (OR 1.34), meconium aspiration (OR 2.85), fetal distress (OR 2.52), and early neonatal death (OR 3.41), as compared with mothers with normal weights; the associations were similar for women with BMI between 35.1 and 40, but to a lesser degree. 41 Table 2 shows the association of the descriptors with gynecologic outcomes or conditions.…”