School of Medicine and Health Sciences Poster Presentations

Title

Risk factors for Venous Thromboembolism in Obese Women Undergoing Cesarean Delivery

Poster Number

160

Document Type

Poster

Status

Medical Resident

Abstract Category

Clinical Specialties

Keywords

Obesity, C-Section, Pregnancy, DVT, PE

Publication Date

Spring 2018

Abstract

Introduction:

Venous thromboembolism is a leading cause maternal mortality in the developed world, responsible for 9.3% of maternal deaths in the US. Obesity and cesarean deliveries are established risk factors for pregnancy related VTE. Guidelines for prophylactic use of anticoagulation in obese women undergoing cesarean delivery are heterogeneous across major organizations. We therefore sought to identify risk factors that make obese patients who deliver via cesarean section more likely to develop VTE and help guide targeted anticoagulation in this population.

Methods:

We conducted a secondary analysis of data from the Maternal-Fetal Medicine Units Network MFMU) Cesarean Registry Database using a case control design. Cases were identified as obese women, with pre-pregnancy BMI >30 Kg/m2, who underwent cesarean deliveries and subsequently developed deep venous thrombosis or pulmonary embolism. These women were compared to a control group of similar obese women, who also underwent cesarean deliveries but did not develop DVTs or PEs. Analyses of risk factors associated with VTE were performed using Chi-Square Test and Fisher’s Exact Test.

Results

Each of the identified 43 VTE cases was matched with 4 controls, for a total of 172 controls. Increased risk of VTE were noted in women with endometritis OR of 4.58 (95% CI: 1.86 - 11.2, p= 0.0004). Other significant risk factors for VTE includes receiving a blood transfusion with OR 17.07 (95% CI: 4.46 – 65.3, p = 0.0001), having a coagulopathy 27.73 (95% CI: 3.24 - 237.25, p=.0003).

Conclusion

Important risk factors for VTE in obese women undergoing cesarean deliveries include endometritis, intraoperative or postoperative transfusion, and coagulopathy. The presence of one or more of these factors may warrant addition of pharmacologic thromboprophylaxis.

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Risk factors for Venous Thromboembolism in Obese Women Undergoing Cesarean Delivery

Introduction:

Venous thromboembolism is a leading cause maternal mortality in the developed world, responsible for 9.3% of maternal deaths in the US. Obesity and cesarean deliveries are established risk factors for pregnancy related VTE. Guidelines for prophylactic use of anticoagulation in obese women undergoing cesarean delivery are heterogeneous across major organizations. We therefore sought to identify risk factors that make obese patients who deliver via cesarean section more likely to develop VTE and help guide targeted anticoagulation in this population.

Methods:

We conducted a secondary analysis of data from the Maternal-Fetal Medicine Units Network MFMU) Cesarean Registry Database using a case control design. Cases were identified as obese women, with pre-pregnancy BMI >30 Kg/m2, who underwent cesarean deliveries and subsequently developed deep venous thrombosis or pulmonary embolism. These women were compared to a control group of similar obese women, who also underwent cesarean deliveries but did not develop DVTs or PEs. Analyses of risk factors associated with VTE were performed using Chi-Square Test and Fisher’s Exact Test.

Results

Each of the identified 43 VTE cases was matched with 4 controls, for a total of 172 controls. Increased risk of VTE were noted in women with endometritis OR of 4.58 (95% CI: 1.86 - 11.2, p= 0.0004). Other significant risk factors for VTE includes receiving a blood transfusion with OR 17.07 (95% CI: 4.46 – 65.3, p = 0.0001), having a coagulopathy 27.73 (95% CI: 3.24 - 237.25, p=.0003).

Conclusion

Important risk factors for VTE in obese women undergoing cesarean deliveries include endometritis, intraoperative or postoperative transfusion, and coagulopathy. The presence of one or more of these factors may warrant addition of pharmacologic thromboprophylaxis.