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Guidelines on thrombophrophylaxis during pregnancy and the puerperium should reflect population characteristics
  1. D Hayes-Ryan1,2,
  2. B Byrne1,2
  1. 1RCSI, Dublin, Ireland
  2. 2Coombe Women's Hospital, Dublin, Ireland

Abstract

Thromboembolic disease (TED) has consistently been identified as one of the leading causes of direct maternal mortality in the CEMACH report, with a reported mortality of 1.94/100 000 maternities.1 In November 2009 the RCOG published a guideline on TED that involves risk assessment of women at booking visit, during any antenatal admission and at delivery and assigns them into low, intermediate or high risk groups. The aim of our study was to determine how the implementation of these guidelines would affect our obstetric population.

A retrospective review of the first 100 women who delivered at the CWIUH in 2010 was conducted and risk stratification applied at the relevant time points. 51 women (i.e., more than half) were deemed to be at intermediate or high risk of TED at some point during pregnancy. 35 of the 51 women (70%) had an increased risk of thrombosis determined by either age > greater than 35, parity ≥3, body mass index (BMI) >30 kg/m2 or history of smoking. The adjusted odds ratio for thrombosis with these risk factors ranges from 1.3 to 3.4 in case controlled studies and there is no evidence that they have an additive or synergistic effect in increasing risk. In our obstetric population, the percentage of women > 35 years is 25.5%, parity ≥3 is 8.5%, BMI >30 kg/m2 is 19% and smoke cigarettes is 16.7%.2

Identification of women at increased risk of TED in pregnancy and administering appropriate thrombophrophylaxis remains paramount. The strategy of accumulating factors that individually have a low risk to assign the category of intermediate or high risk needs to be re-visited especially when these risk factors are prevalent in the population.

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