Incidence, clinical characteristics, and timing of objectively diagnosed venous thromboembolism during pregnancy

doi:10.1016/S0029-7844(99)00426-3

Obstetrics & Gynecology

Volume 94, Issue 5, Part 1, November 1999, Pages 730-734

Presented in part at the 1998 Annual Clinical Meeting of The American College of Obstetrics and Gynecology, New Orleans, Louisiana.

https://doi.org/10.1016/S0029-7844(99)00426-3 Get rights and content

Abstract

Objective: To estimate the incidence, timing, and associated clinical characteristics of objectively diagnosed pregnancy-associated venous thromboembolism.

Methods: We retrospectively reviewed venous thromboembolism cases (deep venous thrombosis and pulmonary embolism) that occurred between 1978 and 1996. Study inclusion criteria required the objective diagnosis with either Doppler ultrasound, venography, impedance plethysmography, pulmonary angiography, ventilation-perfusion scanning, or computed tomography or magnetic resonance imaging.

Results: Among 268,525 deliveries there were 165 (0.06%) episodes of venous thromboembolism (one per 1627 births). There were 127 cases of deep venous thrombosis and 38 cases of pulmonary embolism. Only 14% (23 of 165 patients) had a history of venous thromboembolism. Most cases of deep venous thrombosis were in the left leg (104 of 127, 81.9%), with nearly three quarters of them (94 of 127, 74.8%) occurring during the antepartum period. Among cases of antepartum deep venous thrombosis, half were detected before 15 weeks’ gestation (47 of 95, 49.5%), and only 28 cases occurred after 20 weeks (P < .001). Most of the pulmonary embolisms occurred in the postpartum period (23 of 38, 60.5%) and were strongly associated with cesarean delivery (19 of 36,470 compared with four of 232,032, P < .001).

Conclusion: The incidence of venous thromboembolism during pregnancy is lower than has been previously described. Most cases occurred in the antepartum period, with the risk of deep venous thrombosis appearing to begin even before the second trimester.

Section snippets

Materials and methods

We retrospectively reviewed consecutive cases of deep venous thrombosis and pulmonary embolism at Los Angeles County and University of Southern California Women’s Hospital between January 1, 1978, and December 31, 1996. This study includes some cases of venous thromboembolism previously reported in abstract form (Rutherford S, Montoro M, McGehee W, Strong T. Thromboembolic disease associated with pregnancy: An 11-year review [abstract]. Am J Obstet Gynecol 1991;164:286). Our hospital is a large

Results

During the 19-year period, there were 268,525 births at our hospital, with 36,489 (13.6%) cesarean and 232,036 vaginal deliveries. There were 165 (0.06%) pregnancies complicated by venous thromboembolism, for a total incidence of one per 1627 births. We noted 127 cases of deep venous thrombosis and 38 cases of pulmonary embolism, for incidences of one per 2114 (0.5%) and one per 7066 (0.014%) births, respectively.

Table 1 shows maternal demographics. As evidenced in Table 2, most (95 of 127,

Discussion

This study represents a large compilation of cases of objectively diagnosed thromboembolism during pregnancy. We found that, although thromboembolism rarely occurs in pregnancy, the incidence might be overestimated on the basis of previous reports. Most deep venous thrombosis cases occurred in the antepartum period, especially during the early second trimester. Only a few patients had the classic risk factors for thromboembolism.

In most previous reports, thromboembolism in pregnancy was

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¹: The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, the Department of Defense, or the United States Government.

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Original ArticlesIncidence, clinical characteristics, and timing of objectively diagnosed venous thromboembolism during pregnancy1

Abstract

Section snippets

Materials and methods

Results

Discussion

Am J Obstet Gynecol

Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Obstet Gynecol

Maternal mortality in the United States, 1979–1986

Obstet Gynecol

Maternal mortality in the United StatesReport from the Maternal Mortality Collaborative

Obstet Gynecol

Venous thromboembolic disease in pregnancy

Semin Perinatol

Venous thromboembolism during pregnancy

N Engl J Med

Original Articles
Incidence, clinical characteristics, and timing of objectively diagnosed venous thromboembolism during pregnancy1