임신 또는 분만 시 혈전색전증에 대한 임상적 고찰
Thromboembolism during pregnancy or postpartum
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Background/Aims: Venous thromboembolism (VTE) during pregnancy or postpartum is a major cause of maternal complications and death; however, the risk is uncertain. In this study, we sought to estimate the incidence of VTE during pregnancy and to identify risk factors for pregnancy-related VTE. Methods: We retrospectively evaluated the incidence, risk factors, treatment, and prognosis for VTE based on 40,989 deliveries at Cheil General Hospital, Kwandong University College of Medicine, over a five-year period from February 2003 to January 2008. The risk factors were analyzed by χ2-analysis and forward stepwise logistic regression, and are presented as crude and adjusted odds ratios (ORs) with a 95% confidence interval (CI). Results: The incidence of VTE was 0.042% (17 patients, mean age 32.4±2.5 years), with deep venous thrombosis (DVT) in 0.01% of the patients (4 patients, mean age 31.5±2.9 years), and pulmonary embolism (PE) in 0.032% of the patients (13 patients, mean age 32.6±2.5 years). The postnatal incidence of VTE was higher than the antenatal incidence (2 vs. 15). The main manifestations at the time of diagnosis, in order of frequency, were: dyspnea in 8 patients (62%), chest pain in 4 patients (31%), cough in 2 patients (15%), and syncope in 1 patient (8%). The risk factors for VTE were Cesarean section (OR=7.4; 95% CI: 2.1-25.7, p=0.002) and preeclampsia (OR=12.0; 95% CI: 4.2-34.2, p<0.000). All cases showed clinical improvement spontaneously, or with anticoagulation and surgical thrombectomy, and caused no fetal or maternal mortality. Conclusions: The incidence of VTE during pregnancy was 0.042%; the independent risk factors were Cesarean section and preeclampsia. (Korean J Med 75:658-664, 2008)
Abstract
Background/Aims: Venous thromboembolism (VTE) during pregnancy or postpartum is a major cause of maternal complications and death; however, the risk is uncertain. In this study, we sought to estimate the incidence of VTE during pregnancy and to identify risk factors for pregnancy-related VTE. Methods: We retrospectively evaluated the incidence, risk factors, treatment, and prognosis for VTE based on 40,989 deliveries at Cheil General Hospital, Kwandong University College of Medicine, over a five-year period from February 2003 to January 2008. The risk factors were analyzed by χ2-analysis and forward stepwise logistic regression, and are presented as crude and adjusted odds ratios (ORs) with a 95% confidence interval (CI). Results: The incidence of VTE was 0.042% (17 patients, mean age 32.4±2.5 years), with deep venous thrombosis (DVT) in 0.01% of the patients (4 patients, mean age 31.5±2.9 years), and pulmonary embolism (PE) in 0.032% of the patients (13 patients, mean age 32.6±2.5 years). The postnatal incidence of VTE was higher than the antenatal incidence (2 vs. 15). The main manifestations at the time of diagnosis, in order of frequency, were: dyspnea in 8 patients (62%), chest pain in 4 patients (31%), cough in 2 patients (15%), and syncope in 1 patient (8%). The risk factors for VTE were Cesarean section (OR=7.4; 95% CI: 2.1-25.7, p=0.002) and preeclampsia (OR=12.0; 95% CI: 4.2-34.2, p<0.000). All cases showed clinical improvement spontaneously, or with anticoagulation and surgical thrombectomy, and caused no fetal or maternal mortality. Conclusions: The incidence of VTE during pregnancy was 0.042%; the independent risk factors were Cesarean section and preeclampsia. (Korean J Med 75:658-664, 2008)
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