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170: Pregnancy associated DVT: Can it be used as an indicator of maternal healthcare quality?

      Objective

      Describe pregnancy associated deep vein thrombosis (DVT) and pulmonary embolism (PE) by method of delivery, and evaluate its potential use as an indicator of healthcare quality.

      Study Design

      Using 2003 California discharge data, rates of DVT/PE were calculated for antepartum, delivery, and postpartum discharges at the hospital level. Criteria suggested by Agency for Healthcare Research and Quality was used to evaluate the potential for DVT/PE to be used as a measure of hospital quality-- importance, scientific acceptability, usability, and feasibility.

      Results

      There were 48,015 antepartum admissions, 525,354 delivery discharges, and 17,981 postpartum admissions. Amongst antepartum admissions, there were 139 (0.29%) DVT and 39 (0.12%) cases of PE. There were total of 222 (0.04%) women with delivery associated DVT (180) or PE (42). Women undergoing cesarean delivery were more likely to have DVT/PE as compared to women delivering vaginally (0.09% vs 0.03%)*. Postpartum admissions included 98 (0.55%) and 58 (0.32%) cases of DVT and PE respectively, and were more common among patients with cesarean delivery (0.08% vs. 0.03%)*. The mean rate of DVT/PE for delivery or postpartum admissions by hospital was 0.08% (0% to 1.1%) with 45.5% of hospitals reporting no events. *p<0.0001

      Conclusion

      Women undergoing cesarean delivery are more likely to experience DVT/PE. DVT/PE is not a good quality indicator measure. Although clinically important (significant cause of maternal morbidity and mortality), and scientifically acceptable (prophylaxis could impact incidence), the prevalence is low. It is not usable as a measure of hospital quality of care as rates of DVT/PE do not vary significantly by hospital. It is feasible to monitor based on aggregate data reporting, but further validation is needed to determine the reliability of reporting.