EVALUATING THE INCIDENCE OF THROMBOEMBOLIC DISORDERS DURING PREGNANCY AND PUERPERIUM WITH THEIR PRESENTATION, COMPLICATIONS, AND RISK FACTORS: A PROSPECTIVE OBSERVATIONAL STUDY

Abstract

Background: The risk of thromboembolism in pregnancy is four to five times higher than that of non-pregnant women. Early recognition of signs and symptoms and prompt treatment reduce the morbidity and mortality due to thromboembolic disorders.Cortical venous thrombosis, thrombosis of dural venous sinuses and cerebral veins affects more commonly during the puerperal period, due to the pro thrombotic state. More commonly the patient presents with headache, seizures, papilledema, altered sensorium and focal neurological deficits.The aim of this study is to evaluate the incidence, demography, risk factors, clinical features, diagnosis and management of thromboembolic disorder in pregnancy and puerperal period, and to study the maternal and perinatal outcomes. Methods:This is a prospective observational study including 100confirmed cases (both clinical and radiological) of thromboembolic disorders in pregnancy and puerperal period who were admitted at RMH and Thanjavur medical college hospital during the study period of 18 months (January 2020-June 2021).Data was collected in the schedule and responses were entered in the Microsoft excel. Using Epi info free software available online, the descriptive statistics such as frequency and percentages were calculated. The association between descriptive variables was found using chi square test.Most common symptom is headache contributing to 41.4% followed by convulsions contributing to 27%, Blurring of vision contributing to 15%. Results:A total of 100 cases of thrombosis were evaluated in the present study.Majority of the thromboembolic patients were in the age group 26-35years contributing to 56 patients. The youngest being 16 years and the oldest being 45 years. Mean age found to be 30.5. Among which majority of the thrombosis contribute to puerperal group, post caesarean section 51%, post-natal 29% and post-abortal 10%.The most common sinus involved was Superior Sagittal Sinus contributing to 55.7%, followed by both superior sagittal sinus and transverse sinus contributing to 14.2% among 70 patients. Majority of the thrombosis are venous thrombosis (96 cases).Majority (63.5%) of the thrombosis occurs following caesarean section. Thromboembolism risk increases during multi para contributing to 63% (out of 100 cases). Majority of the patients are overweight contributing to 42%, obese patients contributing to 16%.we found hypertensive disorders (54%), diabetes (12%), Dehydration (5%), sepsis (3%), ventilator (2%) are the most important predisposing factor for thrombosis. Conclusion: The risk factors should be corrected accordingly like anaemia with blood transfusion, pre eclampsia with BP monitoring, early mobilisation in the puerperal period, dehydrated patients with Intravenous fluids and plenty of oral fluids.The risks of thromboembolism (0.05 Vs. 12%) are higher incidence in obese as compared to non-obese. During every antenatal visits, weight ,Hb,urinealbumin ,sugar & BP recording with appropriate sized cuff. Obese women should be evaluated for gestation diabetes at 1st visit.

Keywords

• thromboembolism,deep
• vein thrombosis
• cortical venous thrombosis