الفهرس 
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Abstract
Obstetric venous thromboembolism poses a major life-threating burden, it has been reported that half of the women during pregnancy and postpartum were at risk of VTE and it caused about 10% of maternal deaths.Obstetric venous thromboembolism is associated with real complications such as placental vascular complications, fetal loss, intrauterine growth restriction, HELLP syndrome, haemolysis, elevated liver enzymes, in addition, prolonged unfractionated heparin use during pregnancy may result in osteoporosis and fractures.The prevention of VTE is considered a patient-safety measure in most mandated quality initiatives, the measures for prevention of VTE include mechanical methods such as graduated compression stockings and intermittent pneumatic compression devices and pharmacologic agents, a combination of mechanical and pharmacologic methods produces the best results. The pharmacological type is the major type of VTE prophylaxis and unfractionated heparin is the main anticoagulant used. Factors determining VTE prophylaxis were not intensively studied, but it has been reported recently that obesity, caesarean delivery, ethnicity and immobility were of the significant factors. This is a prospective study that was performed at the Obstetrics and Gynecology dept., Minia maternity university hospital, during the period of one year (from June 2018 to June 2019). The study included a total of 901 women who attended to the hospital at risk of VTE as per the latest criteria of RCOG guidelines. The objective of this study was to assess the incidence of VTE, types of prophylaxis received and factors that could determine prophylaxis in women during pregnancy and puerperium through the study period. The obtained results are summarized as follows:Of the total 901 included women, 298 cases were during pregnancy (33.1%) and 603 cases (66.9%) were during puerperium.
The 901 included women at risk of VTE comprised 8.22% of the total deliveries during the study period (10956 deliveries). The mean age of the cases women was 31.7 ± 9.1 years (19-47) and the mean BMI was 30.7 ± 5.5 kg/m2 (22-42). The majority of them (830 cases, 92.1%) were non-smokers. Regarding parity, about half of them (486 cases, 53.9%) had 1:2 and 363 cases (40.3%) had 3 or more. About two-thirds of them (71.5%) had a caesarean delivery.
As regards the intensity of VTE risk, 423 cases (46.9%) had mild risk, 352 cases (39.1%) had moderate risk and 126 cases (14.0%) had severe risk.
Regarding risk factors if VTE, varicose veins were found in 209 cases (23.2%), previous VTE in 189 cases “21.0%” (pulmonary embolism in 48 cases and lower limb proximal DVT in 91 cases), previous superficial vein thrombosis (SVT) was recorded in 240 cases ”lower limb SVT in 137 cases and upper limb SVT in 54 cases” and previous arterial ischemic events (AIE) in 83 cases (9.2%) ” stroke in 28 cases and MI in 29 cases”. Preexisting medical disorders were found in 190 cases “21.1%” (136 cases of them had diabetes mellitus, 11 cases had chronic heart diseases, 10 cases had chronic neurological diseases).Of the total included cases, 10 cases (1.1%) had thrombophilia and 17 cases (1.9%) had laboratory risk factors.The results showed that 13 (1.4%), 8 (0.9%) and 9 cases (1.0%) had positive family history of VTE, cancer and thrombophilia, respectively.Regarding the type of prophylaxis and treatment received, the vast majority of patients (897 cases 99.6%) received pharmacological treatment (55.6% of them received un-fractionated heparin and the rest of them 43.9% received aspirin) however, only 4 cases received mechanical treatment and 1 case received both types.Of the total 901 included cases, 6 cases developed VTE from the total included cases with an incidence of 0.55/1000 maternities (0.055%). Obesity (BMI >30 kg/ m2) and caesarean delivery were significant factors that determine VTE prophylaxis with an odds ratio of 1.68 (95% CI, 1.20-2.35, p<0.01) and 2.05 (95% CI, 1.49-2.80, p<0.01), respectively.
Regarding the outcome, 47 women (5.2%) had dead babies, 382 (42.4%) had males, 374 (41.5%) had females and 69 cases, 29 cases had twins and triples, respectively.Conclusion and Recommendations The incidence of women perceived at VTE risk during the study period was 8.22% ”which is lower than other studies”, about half of them were mild in intensity. The risk of VTE was higher during the postpartum period than that during pregnancy.The incidence of VTE was 0.55/1000 overall maternities (0.055%).The pharmacological type of prophylaxis was the predominantly used type. Obesity and caesarean delivery were significant factors determining VTE prophylaxis.
The present study has some limitations, of these, we did not assess the knowledge and the attitude of physicians toward the application of the international guidelines and toward VTE prophylaxis. Also, the present results were restricted only for cases attended our hospital and we could not survey cases who were diagnosed and treated outside and this may falsely lower the overall obtained rate of VTE. An additional limitation is that the data were collected from one hospital, although the studied hospital is the main tertiary referral hospital in our region. Finally, further large-scale prospective studies with longer duration and different settings are warranted for focusing on this issue.