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Poster session I Clinical obstetrics, epidemiology, fetus, medical-surgical complications, neonatalogy, physiology/endocrinology, prematurity: Abstracts 87 - 236| Volume 208, ISSUE 1, SUPPLEMENT , S61, January 01, 2013

112: Is there a difference in the risk profile of women who develop thrombo-embolic events in the puerperium or later in life?

      Objective

      Venous thrombo-embolic events (VTE) (mainly pulmonary embolism [PE] and deep vein thrombosis [DVT]) are currently the primary cause for maternal death in the developed world. The study objective was to identify whether risk factors for VTE during the puerperium are different from these of thrombo-embolic events developed later in life during more than 10 years of follow-up.

      Study Design

      A nested case-case study was designed, comparing women who experienced VTE in the puerperium period to women who experienced such an event over a period of a more than a decade. The study included women (n=316) with VTE from a cohort of 48,319 women that gave birth between the years 1987-1998 and had a follow up period until 2011. Multiple logistic regression model was constructed in order to define independent risk factors associated with early (6 weeks) vs. late thrombo-embolic events.

      Results

      VTE during puerperium occurred in 81 women, and in 235 within at least 10 years after the puerperium. Patients encountered VTE during the puerperium had more PE events (n=16, 19.8%) and less DVT events (n=42, 51.9%), compared with the late VTE group (PE n=15, 6.4%; DVT n=159, 67.7%; p< 0.001).
      While baseline characteristics of the two VTE groups were similar (table), women undergoing cesarean section (CS) in the delivery preceding the VTE were more likely to develop early VTE (OR=1.8, 95% Cl=1.05-3.2, P=0.032). Using a multivariate analysis, controlling for confounders such as maternal age, CS was noted as an independent risk factor for early vs. late VTE (adjusted OR=1.9; 95% CI 1.1-3.5; p=0.023).
      Tabled 1Index pregnancy characteristics by time of VTE occurrence
      Table thumbnail grr17

      Conclusion

      The risk profile of both earlier and late VTE are similar, except for cesarean section which is an independent risk factor for early (vs. late) VTE. Women encountered venous thrombo-embolic event during the puerperium are more likely to suffer from pulmonary emboli than women encountering VTE after the puerperium.