Clinical Characteristics and Outcomes of Women Presenting with Venous Thromboembolism during Pregnancy and Postpartum Period: Findings from the RIETE Registry

2020 ◽  
Vol 120 (10) ◽  
pp. 1454-1462
Author(s):  
Islam Y. Elgendy ◽  
Annemarie Fogerty ◽  
Ángeles Blanco-Molina ◽  
Vladimir Rosa ◽  
Sebastian Schellong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Postpartum Period ◽  
Vena Cava ◽  
Adverse Outcomes ◽  
Postpartum Woman ◽  
Postpartum Women ◽  
Vena Cava Filters ◽  
Pregnancy And Postpartum ◽  
Using Data

AbstractAlthough venous thromboembolism (VTE) is a leading cause of maternal mortality, there is a paucity of real-world clinical data on clinical presentation and management of VTE during pregnancy and postpartum period. Using data from the international RIETE (Registro Informatizado Enfermedad Trombo Embólica) registry, pregnant and postpartum women with VTE were identified. Baseline characteristics, risk factors, therapies, and outcomes were compared. From March 2001 to July 2019, 596 pregnant and 523 postpartum women had symptomatic, objectively confirmed VTE. Pregnant or postpartum women were less likely to have another risk factor for VTE (i.e., immobility, cancer, recent travel) than nonpregnant women aged < 50 years. The prevalence of thrombophilia was higher among pregnant and postpartum women compared with nonpregnant women (53.2% vs. 46%). Pulmonary embolism (PE) was less commonly diagnosed in pregnant versus postpartum women (27% vs. 42%). Pregnant women with PE were commonly treated with low molecular weight heparin (73% vs. 29%), and received more inferior vena cava filters (6.0% vs. 4.2%) compared with postpartum women. By 90 days, one pregnant and one postpartum woman died after PE, and one died after a deep venous thrombosis. The incidence of recurrent VTE was low. In this largest cohort of pregnant and postpartum women with confirmed VTE, we found that pregnant and postpartum women with VTE were unlikely to present with other risk factors for VTE. Adverse outcomes in our study were uncommon.

scholarly journals Prophylaxis and management of venous thromboembolism during pregnancy and postpartum period

2021 ◽  
Vol 15 (5) ◽  
pp. 599-616
Author(s):  
V. Ya. Khryshchanovich ◽  
N. Ya. Skobeleva
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Pregnant Women ◽  
Postpartum Period ◽  
Anticoagulation Therapy ◽  
Total Duration ◽  
Factor Xa ◽  
Pregnancy And Postpartum ◽  
Routine Administration ◽  
History Of

Introduction. Venous thromboembolism (VTE) is one of the lead causes for maternal mortality and morbidity during pregnancy in the majority of developed countries. The incidence rate of VTE per pregnancy-year increases during pregnancy and postpartum period about by 4-fold and at least 14-fold, respectively.Aim: to analyze and summarize current view on risk factors of thrombotic events during gestation and to discuss recent guidelines for the management of venous thromboembolic complications during pregnancy and postpartum, by taking into account a balance between risks and benefits of using anticoagulants.Materials and Methods. The literature search covering the last 10 years was carried out in the electronic scientific databases RSCI, PubMed/MEDLINE, and Embase. While formulating a search strategy for evidence-based information, the PICO method (P = Patient; I = Intervention; C = Comparison; O = Outcome) and the key terms “venous thromboembolism” and “pregnancy” were used.Results. Risk factors were found to include a personal history of VTE, verified inherited or acquired thrombophilia, a family history of VTE and general medical conditions, such as immobilization, overweight, varicose veins, some hematological diseases and autoimmune disorders. VTE is considered being potentially preventable upon prophylactic administration of anticoagulants, but no high confidence randomized clinical trials comparing diverse strategies of thromboprophylaxis in pregnant women have been proposed so far. Because heparins do not cross the placenta, weight-adjusted therapeutic-dose low molecular weight heparins (LMWH) represent the anticoagulant treatment of choice for VTE during pregnancy. Once- and twice-daily dosing regimens are acceptable. However, no evidence suggesting benefits for measurement of factor Xa activities and consecutive LMWH dose adjustments to improve clinical outcomes are available. In case of uncomplicated pregnancy-related VTE, no routine administration of vitamin K antagonists, direct thrombin or factor Xa inhibitors, fondaparinux, or danaparoid is recommended. Lactating women may switch from applying LMWH to warfarin. Anticoagulation therapy should be continued for 6 weeks postpartum with total duration lasting at least for 3 months.Conclusion. VTE is a challenging task in pregnant women expecting to apply a multi-faceted approach for its efficient solution by taking into account updated recommendations and personalized patient-oriented features.

scholarly journals Venous Thromboembolism: Classification, Risk Factors, Diagnosis, and Management

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Fatemeh Moheimani ◽  
Denise E. Jackson
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Financial Burden ◽  
Vena Cava ◽  
Intermittent Pneumatic Compression ◽  
Coagulation Cascade ◽  
High Morbidity ◽  
Compression Stockings ◽  
Pharmacological Interventions ◽  
Vena Cava Filters

Venous thromboembolism (VTE) is categorised as deep venous thrombosis (DVT) and pulmonary embolism (PE). VTE is associated with high morbidity and causes a huge financial burden on patients, hospitals, and governments. Both acquired and hereditary risks factors contribute to VTE. To diagnose VTE, noninvasive cost-effective diagnostic algorithms including clinical probability assessment and D-dimer measurement may be employed followup by compression ultrasonography for suspected DVT patients and multidetector computed tomography angiography for suspected PE patients. There are pharmacological and mechanical interventions to manage and prevent VTE. The pharmacological approaches mainly target pathways in coagulation cascade nonspecifically: conventional anticoagulants or specifically: new generation of anticoagulants. Excess bleeding is one of the major risk factors for pharmacological interventions. Hence, nonpharmacological or mechanical approaches such as inferior vena cava filters, graduated compression stockings, and intermittent pneumatic compression devices in combination with pharmacological interventions or alone may be a good approach to manage VTE.

Diastasis Recti Abdominis in Pregnancy and Postpartum Period. Risk Factors, Functional Implications and Resolution

2015 ◽  
Vol 11 (1) ◽  
pp. 59-67 ◽  
Author(s):  
Patricia Mota ◽  
Augusto Gil Pascoal ◽  
Kari Bo
Keyword(s):  
Risk Factors ◽  
Postpartum Period ◽  
Postpartum Women ◽  
Diastasis Recti ◽  
Abnormal Posture ◽  
Pregnancy And Postpartum ◽  
Functional Implications ◽  
Postnatal Women ◽  
Diastasis Recti Abdominis

Diastasis recti abdominis (DRA) or the increased inter rectus distance (IRD) is described as the separation of the rectus abdominis muscles. It can occur during pregnancy and after childbirth. Mota et al. (2015) found DRA may affect up 100% of pregnant women [1], and it may persist separated in the immediate postpartum period in 35% to 60% of women [2]. Reported prevalence of DRA or increased IRD varies and may be inaccurate due to different cut off points for the diagnosis [1-7] and use of different measurement methods. To date limited studies about the normal width of the IRD in postpartum women are available [8, 9], and there is scarce information about risk factors for DRA. There are some theories stating that failure to treat DRA effectively can lead to long term sequelae [10], including abnormal posture [1], lumbo-pelvic pain and cosmetic imperfections [10]. Postnatal women are stimulated to resume abdominal exercises shortly after delivery [3] to improve trunk function and restore abdominal figure and fitness [8]. To date there is scant knowledge on the most effective abdominal exercises both during pregnancy and after childbirth. In particular there is little evidence on which exercises are most efficient in the narrowing of the recti diastasis. The aim of this article is to critically review the literature on the risk factors, functional implications and the effect of exercise on DRA. This information is expected to be relevant for physiotherapists and exercise professionals.

Advanced Management Options for Massive and Submassive Pulmonary Embolism

2016 ◽  
Vol 10 (1) ◽  
pp. 30 ◽  
Author(s):  
Sonika Malik ◽  
◽  
Anju Bhardwaj ◽  
Matthew Eisen ◽  
Sanjay Gandhi ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Vena Cava ◽  
Right Ventricular Dysfunction ◽  
Hemodynamic Instability ◽  
Adverse Outcomes ◽  
Intermediate Risk ◽  
Management Options ◽  
Vena Cava Filters ◽  
Submassive Pulmonary Embolism ◽  
Risk Patients

Pulmonary embolism (PE) is an important cause of morbidity and mortality and presents with significant diagnostic and therapeutic challenges. Clinical presentation ranges from mild, nonspecific symptoms to syncope, shock, and sudden death. Patients with hemodynamic instability and/ or signs of right ventricular dysfunction are at high risk for adverse outcomes and may benefit from aggressive therapy and support. Therapeutic anticoagulation is indicated in all patients in the absence of contraindications. Thrombolysis should be strongly considered in selected high- and intermediate-risk patients, either by systemic infusion or percutaneous catheter-directed therapy. Other therapeutic modalities, such as vena cava filters and surgical embolectomy, are options for patients who fail or cannot tolerate anticoagulation and/or thrombolysis. This article reviews the assessment and advanced management options for acute PE with focus on high- and intermediate-risk patients.

Diagnosis and Initial Treatment of Venous Thromboembolism in Patients With Cancer

2009 ◽  
Vol 27 (29) ◽  
pp. 4889-4894 ◽  
Author(s):  
Michael B. Streiff
Keyword(s):  
Venous Thromboembolism ◽  
Initial Treatment ◽  
Vena Cava ◽  
Initial Therapy ◽  
Primary Objective ◽  
Thrombotic Disease ◽  
Venous Stenting ◽  
Patients With Cancer ◽  
Vena Cava Filters ◽  
Increased Risk

Purpose Venous thromboembolism (VTE) is a common complication of cancer and its therapy. The purpose of this article is to review the diagnosis and initial treatment of VTE in the patient with cancer. Methods I conducted a survey of the English-language literature on topics relevant to the diagnosis and initial treatment of VTE in patients with cancer. Results Patients with cancer are at increased risk for VTE because of the presence of multiple risk factors for thrombotic disease. The most common signs and symptoms of VTE as well as the utility of clinical prediction rules and D-dimer testing in the diagnosis of VTE in the patient with cancer are reviewed. Duplex ultrasound and computer tomography angiography are the primary objective diagnostic modalities for VTE. Low molecular weight heparin is the preferred initial therapy for VTE. Until further data emerge, thrombolysis and vena cava filters should be reserved for patients in whom anticoagulation is insufficient or contraindicated. Outpatient management is feasible for carefully selected patients with cancer with deep vein thrombosis (DVT) and low-risk pulmonary embolism. Anticoagulation is the preferred initial therapy for cancer patients with central venous catheter–associated DVT, calf DVT, and unsuspected VTE. Conclusion Optimal initial management of VTE in patients with cancer entails maintaining a high index of suspicion for thrombotic disease, confirming diagnostic suspicions with objective testing and evidence-based use of anticoagulation, and adjunctive therapeutic modalities (thrombolysis, vena cava interruption, venous stenting). Further investigation of initial diagnostic and treatment strategies for VTE focusing on patients with cancer are warranted.

scholarly journals PREVALENCE AND POSSIBLE RISK FACTORS OF HEMORRHOIDAL THROMBOSIS IN PREGNANCY AND POSTPARTUM PERIOD

2019 ◽  
Vol 6 (4) ◽  
pp. 209-214
Author(s):  
Yuliya S. Medkova ◽  
D. R Markar’yan ◽  
I. A Tulina ◽  
Yu. A Churina ◽  
L. S Aleksandrov ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Postpartum Period ◽  
Patient Management ◽  
Current Data ◽  
Sufficient Evidence ◽  
Evidence Based ◽  
Initial Visit ◽  
Pregnancy And Postpartum ◽  
In Pregnancy

Introduction. Nowadays there are no sufficient evidence based data for a scientifically approach to the treatment of hemorrhoids during pregnancy and after childbirth, as well as current data of the prevalence of hemorrhoidal thrombosis (HT) and possible risk factors. Material and methods. The study included pregnant women and puerperas who were actively diagnosed with chronic hemorrhoids (CH) and HT. The physical examination was performed four times: at the woman’s initial visit to the obstetrician-gynecologist, at 24 weeks of pregnancy, at 36 weeks of pregnancy, in the postpartum period (within 7 days after delivery). Patients suffering from HT were asked to answer a questionnaire to determine possible risk factors. Results. A study was conducted on a population of 668 women. 104 women was diagnosed with CH in the postpartum period, and 81 - during pregnancy. The median VAS score with HT was 7. Second delivery, age over 30 years old, lack of physical activity during pregnancy and vaginal delivery are possible risk factors for the development of HT. Conclusions. In the presence of a high risk of HT during pregnancy and in the postpartum period, preventive examinations by a coloproctologist are an important aspect of patient management.

scholarly journals Risk Factors for Postpartum Depression During COVID-19 Pandemic: A Systematic Literature Review

2021 ◽  
Vol 12 ◽  
pp. 215013272110593
Author(s):  
Sadia Usmani ◽  
Elona Greca ◽  
Sana Javed ◽  
Medha Sharath ◽  
Zouina Sarfraz ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Literature Review ◽  
Postpartum Depression ◽  
Systematic Literature Review ◽  
Adverse Outcomes ◽  
Depression Symptoms ◽  
Postpartum Women ◽  
Negative Consequences ◽  
Symptoms Of Depression

Introduction: The COVID-19 pandemic has had a devastating worldwide effect on mental health. Recent studies correlate the spreading of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with symptoms of depression, most prominent in postpartum women. Our systematic literature review scope is to identify the risk factors and predictors for postpartum depression (PPD) and describe the steps that should be taken to help postpartum women. This study will help clinicians, researchers, and policymakers to elucidate the predictors of PPD during this pandemic and prevent these adverse outcomes in future crises. Methods: We conducted a systematic search by employing databases PubMed, Google Scholar, Scopus, and Embase to identify articles published before March 2021. About 463 publications were generated during our search process and from those, 36 were reviewed, summarized, and synthesized. Studies qualified the criteria if they (1) utilized qualitative or quantitative design, (2) explored the risk factors for PPD, and (3) were written in English. Quality evaluation of each study was achieved by using criteria set by Lincoln and Guba. Results: Prevalence of depression symptoms ranged from 7% to 80.8% in postpartum women during the SARS-COV 2 pandemic. The risk factors for PPD were classified into 6 major categories: socio-demographic, psychological, pre-existing pathology, metabolic factors, previous events of miscarriage, and media misinformation. Conclusion: It is extremely vital to care for women’s mental health during pregnancy and after childbirth during these unprecedented times. This review urges the need to design adequate interventions for this vulnerable population to prevent negative consequences of PPD.

Sign in / Sign up

Export Citation Format

Share Document