Risk Assessment and Thromboprophylaxis for Venous Thromboembolism in the Puerperium in a Health Facility in Nigeria. [Abstract presentation]. 9th Annual General Meeting and Scientific Conference of the (piSON

Abstract

Background: Venous thromboembolism (VTE) is a leading cause of maternal morbidity and mortality. Overall incidence in pregnancy and puerperium is 1- 2 per 1000 pregnancies and it peaks in the first 3 weeks postpartum. Careful assessment of risk factors for VTE and employing optimum thromboprophylaxis can prevent VTE. Unfortunately in Nigerian tertiary institutions, there is paucity of information about its risk factors, screening for it, and its prophylaxis. In the developed countries, the relative risk of VTE in pregnancy was found to be increased by four- to six-folds, and this was increased further in the postpartum period. Despite the fact that VTE is a leading cause of maternal morbidity and mortality, there is still paucity of information in our environment. There is also a clear evidence that identification of risk factors with subsequent thromboprophylaxis of the at-risk population will reduce the occurrence of morbidity and mortality caused by VTE

Objective: To evaluate the practice of risk assessment, thromboprophylaxis and to determine those who would have needed thromboprophylaxis

Methods: A retrospective cross-sectional study carried out at the University of Port Harcourt Teaching Hospital (UPTH).The data extracted from 212 hospital notes of inpatient postpartum women from January 2019 to January 2020 were as follows: Demographic characteristics, risk factors for VTE, thromboprophylaxis, diagnosis and treatment of VTE.VTE risk was assessed using the RCOG guideline of 2015. Women with a VTE event in the preceding 4 months before pregnancy were excluded Data was analyzed using a Statistical Package for Social Science (SPSS) software, version 18.

Discussion: This study has highlighted that in our tertiary health institution, the practice of risk assessment in patients is not done despite the fact that VTE is the leading cause of maternal morbidity and mortality in our setting. Majority of these patients had risk factors for VTE and did not receive Thromboprophylaxis to prevent the attendant sequalae in the puerperium. There was no patient among the 212 study population that had retrospective VTE assessment who did not have at least 1 risk factor for VTE. Out of the 212 Patients, 2(0.94%) scored ''1'' each for risk of developing VTE and therefore would not have needed LMWH in the puerperium according to the NICE guideline. The advice for them would have been to mobilise and avoid dehydration. Irrespective of the presence or absence of other risk factors, 204(96.23%) of the patients had either prolonged admission to hospital for more than 3 days or were readmitted after initial discharge from the hospital. They scored ''3'' each for VTE risk and therefore belong to the intermediate risk category. They would have needed LMWH for 10 days postpartum and would have continued on it beyond 10 days if risk persisted.

Conclusion: The study showed that irrespective of the morbidity and mortality that VTE could cause, assessment for its risk and prophylaxis was not a routine practice at the tertiary centre as at the time of the study. The prevalence of risk factor was high in the study population as 99.06% of the study population were at significant risk of developing VTE. No case of VTE was recorded in the study population, although there was a case of unexplained sudden death

Disclosure: None