| Objective :To investigate the incidence,characteristics and risk factors of perinatal venous thromboembolism(VTE)in 112 pregnant women in our hospital,so as to provide clinical basis for clinical diagnosis and prevention.Research materials and methods:The incidence and clinical characteristics of 112 pregnant women with perinatal VTE who were hospitalized in the obstetrics department of the First Hospital of Jilin University from May 2018 to December 2021 were analyzed retrospectively.109 patients with VTE within 1 week after delivery were selected as the case group,and198 patients with negative vascular ultrasound results were randomly selected as the control group.To find the risk factors of perinatal VTE,evaluate the predictive value of each risk factor for VTE,and provide reference for prevention,diagnosis and treatment.Results:1.From May 2018 to December 2021,there were 112 cases of new VTE patients in perinatal period in our hospital,with an incidence of 8.76 ‰.Among them,3 patients had VTE before delivery,and 109 patients had VTE within 1week after delivery.The incidence rates before and after delivery were 0.23 ‰ and8.53 ‰.Among them,102 cases were IDDVT,the right lower limb IDDVT was slightly more than the left lower limb IDDVT,2 cases were PDVT,7 cases were PE,and 1 case was intracranial venous thrombosis.The most VTE events were found on the first day after delivery,accounting for 48.2 %.VTE was found in 86.6 % of patients within 3days after delivery.2.The incidence of symptomatic VTE patients in our hospital is close to the previous high value of VTE in western developed countries,and the proportion of IDDVT is higher than that of previous studies.3.There were statistically significant differences between the case group and the control group in age,pre-pregnancy BMI,surgical history,family history,age ≥ 35 years,TT,APTT,FBI,albumin,red blood cells,HB,gestational age at delivery,gestational age at delivery < 37 weeks,cesarean delivery,red blood cell transfusion during and after delivery,blood transfusion cases,blood loss during delivery,hypertensive disorder complicating pregnancy,uterine atony,postpartum hemorrhage(P < 0.05).4.Age,pre-pregnancy BMI,thrombin time(TT),gestational age < 37 weeks,cesarean section,hypertensive disorder complicating pregnancy and postpartum hemorrhage were independent risk factors for perinatal VTE(P < 0.05).The OR values were 1.081,1.087,1.215,3.866,7.837,3.001 and 4.257,respectively.Among them,age,pre-pregnancy BMI,thrombin time,gestational age < 37 weeks,cesarean delivery,and hypertensive disorder complicating pregnancy had certain predictive value(P < 0.05).The AUC values were 0.633,0.597,0.614,0.625,0.623,and 0.599,respectively.The predictive value of postpartum hemorrhage was low(P >0.05).The AUC value of the above factors was 0.805.The best cut-off value of age was 32.5 years old,the sensitivity was 56.9 %,and the specificity was 66.7 %.The best cut-off value of pre-pregnancy BMI was 22.16,the sensitivity was 62.4 %,and the specificity was 58.1 %.The optimal cut-off value of thrombin time was 13.85 s,the sensitivity was 84.4 %,and the specificity was 39.9 %.5.Among patients with improved D-dimer,D-dimer is an independent risk factor for perinatal VTE,with an OR value of 1.201.When the D-dimer value was 3.155 ug / ml,the Youden index was the largest,the sensitivity was72.5 %,and the specificity was 68.3 %.6.In the perinatal VTE patients with hypertensive disorder complicating pregnancy,the difference of D-dimer value was statistically significant(P < 0.05),and it was an independent risk factor for VTE in hypertensive disorder complicating pregnancy,with an OR value of 1.525.When the value was 3.595 ug / m L,the sensitivity was 75 % and the specificity was 80 %.7.There was no significant difference between IDDVT group and non-IDDVT group.Conclusion:1.During this period,the incidence of perinatal VTE in our hospital was much higher than that in previous studies,and the incidence of VTE increased within 1 week after delivery.Most VTE occurs within 3 days of delivery and has no obvious clinical manifestations.It is only diagnosed by CUS screening.With IDDVT as the main type,the number of right lower limbs is slightly more than that of left lower limbs,which is different from previous experience.If CUS of both lower limbs is performed early after delivery,it can achieve the effect of early detection.According to the proportion of IDDVT to DVT,early detection,early diagnosis and early treatment can prevent some patients from progressing to PDVT and PE.2.Many risk factors have certain diagnostic value for perinatal VTE,but the diagnostic value of single risk factor for perinatal VTE is limited,and the diagnostic value of multi-factor combined evaluation is higher.In this study,D-dimer also has certain auxiliary diagnostic value,or can be included in the assessment of risk factors.3.Perinatal patients with lower limb swelling and pain,chest tightness,headache and other discomfort should be diagnosed as soon as possible.For pregnant women with high risk factors such as advanced age,obesity,hypertensive disorder complicating pregnancy,cesarean delivery,premature delivery and postpartum hemorrhage,health education and prevention of VTE should be strengthened.4.When TT ≥ 13.85 s before delivery,the diagnostic sensitivity was higher(84.4 %).At the same time,it is suggested that patients may have changes in coagulation status before delivery,which may lead to the occurrence of VTE.5.In patients with gestational hypertension,prenatal D-dimer ≥ 3.595 ug / m L is an independent risk factor for VTE,which may be used as a new predictor of VTE in patients with pregnancy-induced hypertension.Clinically,the target patients can be tested to achieve early identification,early prevention,early diagnosis,and early treatment to reduce the occurrence of adverse events.6.The progression of IDDVT to PDVT and PE is difficult to assess.How to prevent this progression is the key to VTE treatment,but further research is needed. |
PDF Full Text Request