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Background: The role of anticoagulation in ovarian vein thrombosis (OVT) is uncertain. Objectives: We aimed to evaluate safety and efficacy of anticoagulant treatment in OVT patients. Methods: A systematic search was conducted in MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases up to April 2024. Eligible studies included randomized controlled trials and observational studies enrolling at least 10 adult patients with objectively diagnosed OVT and treated with any anticoagulants. The protocol was prospectively registered in the International Prospective Register of Systematic Reviews (CRD42021270883). Results: We included 17 observational studies (621 anticoagulated and 376 nonanticoagulated OVT patients); 9 studies enrolled mainly pregnancy/puerperium-related OVT. Most patients received heparins alone (45.7%) or proceeded to vitamin K antagonists (39.2%). The average treatment duration was ≤3 months in 8 studies (47.1%), >3 to ≤6 months in 6 studies (35.3%), and >6 months in 3 studies (17.6%). In treated patients, mortality rate was 2.43% (95% CI, 0.54%-5.41%; I2 = 53.8%; 12/406 patients; 13 studies), major bleeding was 1.27% (95% CI, 0.48%-2.38%; I2 = 2.5%; 7/583 patients; 15 studies), recurrent venous thromboembolism (VTE) was 3.49% (95% CI, 1.12%-6.95%; I2 = 63.5%; 22/482 patients; 15 studies), and vessel recanalization was 89.4% (95% CI, 74.6%-98.6%; I2 = 80.6%; 163/184 patients; 8 studies). The rate of recurrent VTE in untreated patients was 8.65% (95% CI, 2.61%-17.35%); however, the difference compared with treated patients was not statistically significant (risk ratio, 0.70; 95% CI, 0.36-1.37). At subgroup analyses, the rates of major bleeding and recurrent VTE were 0.80% (95% CI, 0.0-2%.17%) and 3.81% (95% CI, 0.42%-9.63%) in pregnancy/puerperium-related OVT, respectively, and 1.12% (95% CI, 0.32%-2.34%) and 1.78% (95% CI, 0.62%-3.46%), respectively, when analyzing only full-text studies. Conclusion: There is paucity of literature regarding OVT. Our results suggest that anticoagulation is associated with low rates of major bleeding and recurrent VTE.
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BACKGROUND AND OBJECTIVES: Postpartum anaemia is a prevalent health problem. We aimed to determine the compliance rate for red blood cell (RBC) transfusion indication among postpartum women in a single tertiary care centre in Quebec, Canada. MATERIALS AND METHODS: Retrospective cohort study including all women ≥6 h postpartum who received ≥1 RBC transfusion during their delivery hospitalization between January 2005 and February 2022. We determined our centre's compliance rate by indication as compared to current society guidelines, all published after 2015 (Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis [NATA], Royal College of Obstetricians and Gynaecologists [RCOG], American College of Obstetricians and Gynecologists [ACOG]). We then explored predictors of guideline non-compliance and described transfusion practices in our centre. RESULTS: A total of 171 women were included. Our centre's compliance rate was 79.5% (95% confidence interval [CI] 72.7-84.8). Predictors of guideline non-compliance were maternal medical comorbidity or abnormal placentation, both limited by large CIs (odds ratio [OR] 2.26, CI 1.02-4.94, p = 0.04; OR 4.00, CI 1.31-12.06, p = 0.01, respectively). Postpartum haemorrhage was diagnosed among 68% of the cohort, mostly due to uterine atony (73.3%). Mean baseline and nadir haemoglobin were 111 g/L (±18) and 62 g/L (±7.7), respectively. Multiple unit initial transfusion was found in a majority of patients (63.7%). Iron therapy was administered to 51.5% of women in-hospital and 81.9% received an oral iron prescription at discharge. There were no differences in primary or secondary outcomes subsequent to relevant guideline publication. CONCLUSION: Our centre's compliance rate for RBC transfusion indication meets current practice guidelines. Areas for improvement include single-unit initial transfusion protocols and adjuvant iron treatment. Antenatal optimization of haemoglobin and ferritin stores may limit postpartum transfusions.
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Background: The incidence of serious complications during vaginal delivery with a passive second stage in women with medical conditions is unknown. Methods: Our retrospective cohort study with matched groups (pairing 1 passive with 2 active second stage) included women who had a medical delivery plan from the high risk obstetric team at our center. The primary outcome was a composite of major maternal and neonatal complications. Results: The primary outcome occurred in 50% (12/24) of women in the passive group versus 35.4% (17/48) (p = 0.24) in the active group. In the passive group, we observed a longer passive second stage of labor (28 vs. 8â min, p < 0.001), a tendency towards more assisted vaginal births (29.2% vs. 12.5%, p = 0.08), and more traumatic deliveries (16.7% vs. 0%, p = 0.012). Conclusion: The higher proportion of complications in women who had a passive second stage should encourage physicians to make this recommendation only in selected cases.
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Introduction: Postpartum hypertensive disorders of pregnancy occur in 2-5% of pregnancies. It is a major cause of urgent postpartum consultation and is associated with life-threatening complications. Our objective was to evaluate if local management of postpartum hypertensive disorders of pregnancy was congruent with expert recommendations. Methods: We conducted a quality improvement initiative through a retrospective single-centre cross-sectional study. All women over 18-year-old consulting emergently for hypertensive disorders of pregnancy in the first six weeks postpartum, from 2015 to 2020, were eligible. Results: We included 224 women. Optimal management of postpartum hypertensive disorders of pregnancy was observed in 65.0%. While diagnosis and laboratory work-up were excellent, adequate blood pressure surveillance and recommendations upon discharge of an outpatient postpartum episode (69.7%) did not meet expectations. Conclusion: Efforts should be targeted to improve discharge recommendations on optimal blood pressure surveillance after delivery for women at risk for hypertensive disorders of pregnancy and for postpartum hypertensive disorders of pregnancy in women treated as outpatients.
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Background: Hypothyroidism affects 3% of pregnant women, and to date, no studies have addressed the impact levothyroxine-treated hypothyroidism on delivery outcome. Methods: This retrospective cohort study was conducted among 750 women with a singleton pregnancy who gave birth between 2015 and 2019. Delivery modes were compared between 250 hypothyroid women exposed to levothyroxine and 500 euthyroid control women. The aim of this study was to determine the impact of levothyroxine exposure on delivery outcome. Results: Multiple logistic regression showed no significant association between exposure to levothyroxine and the overall rate of caesarean delivery (aOR 1.1; 95% CI 0.8 to 1.6). Mean TSH concentrations were significantly higher throughout the pregnancy in hypothyroid women despite levothyroxine treatment. Maternal and neonatal outcomes in both groups were not different. Conclusion: Hypothyroidism treated with levothyroxine during pregnancy according to local guidelines is not a significant risk factor for caesarean delivery.
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Background: Sufficient exposure to rarer medical problems around pregnancy is a challenge during short rotations in obstetric medicine (OM). A Canadian research group created online clinical cases, the CanCOM cases, to overcome this. Methods: We conducted an exploratory study to document the use and perceived utility of the CanCOM cases. 77 residents doing an OM rotation participated in our study. We used a survey to document their perception of CanCOM cases (12 items, 7-point scale), clinical exposure to several conditions (pre and post rotation; 41 items, 7-point scale) and use of the educational tool (1 item, 4-option scale). Results: CanCOM cases was perceived as an accessible and useful tool. Participants completed a median of 6/20 cases (range 1-20), and highly recommended the cases (6.48 ± 0.73 SD on a 7-point Likert scale). Conclusion: Despite some technical limitations, CanCOM cases was shown to contribute to clinical exposure to rare but essential medical conditions.
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Hypertension , Pregnant Women , Female , Humans , Hypertension/epidemiology , Hypertension/therapy , Incidence , Infant Mortality , Pregnancy , Watchful WaitingABSTRACT
BACKGROUND: Pelvic vein thrombosis (PVT) is a rare complication of pregnancy that can lead to life-threatening complications, such as pulmonary embolism (PE). OBJECTIVE: To describe characteristics of PVT and its treatment in pregnancy in the province of Quebec, Canada. PATIENTS/METHODS: We developed a province-wide case series of PVT in pregnancy including four tertiary care centers and the Registry of Rare Diseases of the Groupe d'Étude en Médecine Obstétricale du Québec. Using diagnostic codes, we included cases with confirmed PVT on imaging during pregnancy or within 6 weeks postpartum from July 2003 to June 2018. RESULTS: A total of 47 cases were identified. PVT diagnosis was generally made in the early postpartum period (median of 9 [interquartile range (IQR) 4.5-12] days postpartum). Most PVT (94%) included in this series were symptomatic. Women presented primarily with abdominal pain (77%) and fever (55%), often prolonged despite antibiotics (mean 4.45 ± 2.39 days, with 39% having fever for more than 5 days). The most common risk factor was surgery (57%) and peripartum infections (54%). Thirty-eight (83%) women received antibiotics and 41 (89%) were anticoagulated. Three cases of PE (7%) occurred concomitantly, 11% of women required intensive care, and 19% had inferior vena cava (IVC) clot extension. The episode resulted in prolonged hospitalization (median 6 [IQR 3-10.75] days), with 48% being hospitalized more than 7 days. CONCLUSION: Symptomatic PVT has significant clinical implications with prolonged fever and risks of extension in the IVC and PE, leading to prolonged hospitalization including in the intensive care unit. Therapeutic anticoagulation and antibiotics, when infection is documented, should be considered for management.
Subject(s)
Pulmonary Embolism , Thrombosis , Vena Cava Filters , Venous Thrombosis , Abdominal Pain , Female , Humans , Pregnancy , Vena Cava, Inferior , Venous Thrombosis/diagnosis , Venous Thrombosis/drug therapy , Venous Thrombosis/epidemiologyABSTRACT
OBJECTIVE: To evaluate patients' knowledge, risk perception, and anxiety about future health risks after an episode of hypertensive disorder of pregnancy (HDP), as well as their satisfaction with an educational pamphlet. METHODS: From January 2016 to June 2017, participants were randomly assigned to one of 2 groups and asked to complete questionnaire #1 (demographics, knowledge, risk perception, anxiety, and satisfaction) after receiving medical counselling at the HDP postpartum clinic. Participants in the intervention group then received the educational pamphlet. One month later, both groups completed the questionnaire again (questionnaire #2). The primary outcome of this study was improvement in the global knowledge score at 1 month, reflecting improved understanding of the health risks of HDP. Secondary outcomes included retention of information, risk perception, satisfaction, and anxiety level. RESULTS: Of 137 eligible women, 57 were randomly assigned to the intervention group and 56, to the control group. Participants in both groups had similar baseline characteristics. Thirteen percent of participants did not complete questionnaire #2. The knowledge score was higher in the intervention group than the control group at 1 month, (88.2%; 95% confidence interval [CI] 26.37-28.32 and 71.3%; 95% CI 20.78-23.45, respectively [P <0.0001]). No difference was seen in anxiety level between the groups (4.0 ± 1.00 vs. 3.8 ± 0.92; Pâ¯=â¯0.6746). The intervention group was highly satisfied with the medical counselling they received (5.5 ± 0.84 out 6) and with the pamphlet (5.6 ± 0.66 out 6). CONCLUSION: The educational pamphlet increased women's knowledge about future health risks of HDP without increasing anxiety and it may be helpful in promoting lifestyle changes necessary to modify these risks.
Subject(s)
Health Knowledge, Attitudes, Practice , Hypertension, Pregnancy-Induced , Pamphlets , Patient Education as Topic/methods , Adult , Anxiety/psychology , Female , Humans , Perception , Pregnancy , Surveys and QuestionnairesABSTRACT
OBJECTIVE: To evaluate complications associated with early postpartum therapeutic anticoagulation. METHODS: A multicenter retrospective cohort study was done to evaluate the association between therapeutic anticoagulation postpartum and major complications (hemorrhagic and wound complications). Secondary outcomes included minor complications, risk factors associated with total complications (including the time to therapeutic anticoagulation resumption after delivery) and recurrent thrombotic events within 6 weeks postpartum. RESULTS: From 2003 to 2015, 232 consecutive women were treated with therapeutic anticoagulation within 96 hours postpartum; among those treated, 91 received unfractionated heparin, 138 received low-molecular-weight heparin, and three received other anticoagulants. The primary outcome, a composite of major hemorrhagic complications (requiring transfusion, hospitalization, volume resuscitation, transfer to intensive care unit, or surgery) and major wound complications, occurred in 7 of 83 (8.4%) for cesarean deliveries and 9 of 149 (6.0%) for vaginal deliveries (P=.490). Total complications (including major and minor hemorrhagic and wound complications) occurred in 13 of 83 (15.7%) for cesarean deliveries compared with 9 of 149 (6.0%) for vaginal deliveries (P=.016). When comparing cases associated with and without complications, the median delay before resuming anticoagulation was significantly shorter for both cesarean (12 vs 33 hours, P=.033) and vaginal deliveries (6 vs 19 hours, P=.006). For vaginal deliveries, 8 of 51 (15.7%) women had complications when anticoagulation was started before 9.25 hours postpartum, compared with 1 of 98 (1.0%) when started after 9.25 hours. For cesarean deliveries, 7 of 21 (33.3%) of women experienced complications compared with 6 of 62 (9.7%) if anticoagulation was started before or after 15.1 hours, respectively. Two (0.9%) episodes of venous thromboembolism occurred within 6 weeks postpartum. CONCLUSION: Among postpartum women who received early therapeutic anticoagulation, major complications occurred in 8.4% for cesarean deliveries and 6.0% for vaginal deliveries. Complications were associated with earlier resumption of therapeutic anticoagulation, particularly before 9.25 hours for vaginal deliveries and before 15.1 hours for cesarean deliveries.
Subject(s)
Anticoagulants/adverse effects , Postpartum Hemorrhage/epidemiology , Adult , Anticoagulants/therapeutic use , Cesarean Section/adverse effects , Delivery, Obstetric/adverse effects , Female , Heparin/adverse effects , Heparin/therapeutic use , Heparin, Low-Molecular-Weight/adverse effects , Heparin, Low-Molecular-Weight/therapeutic use , Humans , Obstetric Labor Complications/chemically induced , Obstetric Labor Complications/epidemiology , Postpartum Hemorrhage/chemically induced , Pregnancy , Retrospective Studies , Risk Factors , Venous Thromboembolism/drug therapy , Wounds and Injuries/chemically induced , Wounds and Injuries/epidemiology , Young AdultABSTRACT
Extra-hepatic portal vein thrombosis (EHPVO) represents the obstruction of the portal vein outside the liver and is not related to chronic liver disease or neoplasia. In chronic EHPVO, collateral veins and portal hypertension develop, resulting in splenomegaly and variceal formation. Myeloproliferative neoplasms (MPN) are the most frequent acquired etiology of EHPVO. These conditions put pregnant women at increased risk of vascular complications, including venous thrombosis, occlusion of the placental circulation, and variceal bleeding. In this report, we present a 36-year-old pregnant woman with chronic, anticoagulated EHPVO secondary to latent MPN who developed severe intrauterine growth restriction and had cesarean section at 32+1 weeks for increased umbilical doppler resistance and breech presentation. The article will emphasize outcome and management of pregnancies complicated by chronic EHPVO, portal hypertension, and MPN.
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OBJECTIVE: This study aimed to evaluate the impact of educational tools concerning pre-eclampsia on knowledge, anxiety, and women's satisfaction. METHODS: The investigators conducted a randomized controlled trial from March to July 2014 at the Centre Hospitalier Universitaire de Sherbrooke (Sherbrooke, QC) by comparing ambulatory pregnant women (20-32 weeks of gestation) who were receiving educational tools on pre-eclampsia with control patients who received routine care. Tools consisted of an informative pamphlet, a video, and a pictographic magnet, all validated by a multidisciplinary team. The primary outcome was global knowledge (number of correct answers on 35 items) about the disease after 1 month, as assessed by questionnaire. Secondary outcomes included anxiety regarding pre-eclampsia and satisfaction concerning the different tools (a 1-6 Likert scale was used). RESULTS: Among 362 pregnant women approached for the research, 269 were randomized. After 1 month, 247 questionnaires (92%) were filled and analyzed: 122 from the control group and 125 from the intervention group. Baseline characteristics were similar between the groups. Patients who received the tools scored significantly higher on global knowledge (70.1% ± 19.2% compared with 51.1% ± 23.4%; mean difference of 19.0%; P < 0.001). Anxiety scores regarding pre-eclampsia were similar between the groups, with a mean of 2.40 out of 6 for the control group and 2.53 out of 6 for the intervention group (equivalence test, P < 0.001). High score levels of satisfaction for the pamphlet and video were found: 5.1 out of 6 and 5.2 out of 6, respectively. CONCLUSION: These well-received educational tools for pregnant women increased their knowledge about pre-eclampsia without increasing their anxiety about it. Women reported the highest satisfaction for the tools.
Subject(s)
Health Knowledge, Attitudes, Practice , Patient Education as Topic , Patient Satisfaction , Pre-Eclampsia/psychology , Prenatal Care , Adult , Female , Humans , Pregnancy , Treatment OutcomeABSTRACT
BACKGROUND: Little evidence exists for the optimal management of atrial fibrillation with a structurally normal heart in pregnancy. METHODS: A survey was sent to members of two associations to obtain input on optimal management of atrial fibrillation in pregnancy. The survey presented four cases with respect to (1) baseline investigations; (2) rate versus rhythm control; (3) chemical versus electrical cardioversion; and (4) anticoagulation. RESULTS: Sixty-one responders from 11 countries participated. High agreement was noted for baseline investigations. A quarter (25%) of participants chose elective cardioversion even with a reversible precipitant. Electrical cardioversion was preferred over chemical (p < 0.05). Anticoagulation strategies were heterogeneous except in the presence of a left atrial appendage thrombus. DISCUSSION: This study revealed that there was little consensus in current practice in pregnancy beyond basic investigations. An adaptation of established guidelines to the pregnant population would require a meeting of Cardiologists with input from colleagues in Obstetric Medicine.
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OBJECTIVES: Atrial fibrillation (AF) in a structurally normal heart is rare during pregnancy. We wished to use our experience to expand the literature on the causes and management of this condition. METHODS: All members of Groupe d'Étude en Médecine Obstétricale du Québec (GÉMOQ) were invited to record cases of AF in a structurally normal heart during pregnancy to the group's Registry. We searched Medline, PubMed, and Google Scholar (1946 to 15 April 2016) for relevant articles using the key words "atrial fibrillation" and "pregnancy." RESULTS: Sixteen pregnancies with AF in 12 women were recorded in the Registry, and 19 pregnancies with AF in 18 women were retrieved from the literature. The majority (94% in the Registry and 89% in the literature) presented with paroxysmal AF. We found differences between characteristics recorded in the literature and in the Registry; these were the presence of classic triggers for AF (37% in the literature vs. 0% in the Registry), the rate of recurrence of AF in the same pregnancy (5% vs. 31%) or in subsequent pregnancies (1 vs. 4), the rate of spontaneous cardioversion (50% vs. 81%), the use of acetylsalicylic acid and/or low molecular weight heparin as stroke preventive therapy (35% vs. 71%), and the rate of AF influencing the decision to deliver (21% vs. 6%). One woman in the Registry with persistent AF had a left atrial appendage thrombus. CONCLUSION: The GÉMOQ's Registry added 12 cases (16 pregnancies) to the existing literature. AF during pregnancy is an arrhythmia that is mainly unprovoked, paroxysmal, and stable, with spontaneous cardioversion occurring usually within 24 hours. It is associated with good pregnancy outcomes.
Subject(s)
Atrial Fibrillation , Pregnancy Complications, Cardiovascular , Registries , Adult , Female , Humans , Pregnancy , Retrospective Studies , Young AdultABSTRACT
BACKGROUND: The current Canadian guidelines endorse the use of MgSO4 for treatment of eclampsia and for prophylaxis in severe preeclampsia. Our study aimed to audit our institution's compliance regarding these guidelines. METHODS: We conducted a retrospective study to evaluate MgSO4 use in: all our cases of eclampsia since 2002, 50 cases of severe preeclampsia, and 50 cases of non-severe preeclampsia. RESULTS: Sixty-five cases of preeclampsia were analyzed after initial chart review. A high rate of preeclampsia severity misdiagnosis was observed (35%, 23/65). Only 69% (25/36) of the patients correctly diagnosed with severe preeclampsia received MgSO4; after diagnosis correction, 42% (25/59) of the patients with severe preeclampsia received the medication. Of our eight cases of eclampsia, none of the patients received MgSO4 before the seizure (although three had clear indications). CONCLUSION: Given the importance of prophylactic MgSO4 use in preventing eclampsia, we have implemented informative measures aimed at rapidly achieving complete compliance with the national guidelines.
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OBJECTIVE: Rupture of hepatic hematoma associated with hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome is a catastrophic complication of pregnancy. Maternal and fetal mortality rates are still high despite advances in diagnosis and treatment. We aimed to present our experience at two referral centers for hepatic disease and to compare it with cases from the literature. METHODS: We reviewed nine cases that occurred over the past 6 years in our centers and made an extensive literature review covering the past 10 years. We reviewed and compared multiple outcomes for all these cases. RESULTS: The median maternal age of our patients was 29 years (interquartile range 27-32). Embolization treatment was used with seven of nine (78%) of our patients compared with 5 of 88 (6%) in the literature (P<.001). Our maternal and fetal mortality rates were 0% (95% confidence interval [CI] 0-34%) and 30% (95% CI 7-65%), respectively, compared with 17% (95% CI 10-26%) and 38% (95% CI 31-52%]) from our review of the literature from 2000 to 2010. CONCLUSION: The use of hepatic artery embolization to address hepatic rupture associated with HELLP syndrome may help minimize morbidity and maternal mortality.
Subject(s)
Embolization, Therapeutic , HELLP Syndrome/therapy , Hematoma/complications , Hemolysis , Liver Diseases/therapy , Pregnancy Complications, Hematologic/therapy , Adult , Blood Platelets , Female , Fetal Mortality , Hepatic Artery , Humans , Liver Diseases/diagnosis , Maternal Age , Maternal Mortality , Pregnancy , Pregnancy Complications, Hematologic/diagnosis , Rupture, Spontaneous/diagnosis , Rupture, Spontaneous/etiology , Rupture, Spontaneous/therapy , Young AdultABSTRACT
BACKGROUND: Renal cell carcinoma (RCC) during pregnancy is rare. Volume doubling time for RCC is estimated to be 72 weeks. CASE: A 28-year-old woman was assessed for macroscopic hematuria at 21 weeks' gestation. A renal ultrasound revealed a 3.4 cm right renal mass. After MRI, the most likely diagnosis seemed to be angiomyolipoma. The patient opted for conservative management, and the pregnancy continued to almost 36 weeks, at which time the mass had tripled in size. Laparoscopic nephrectomy was performed four days after delivery, and pathological examination revealed a 9.3 cm renal cell carcinoma. Three months later, multiple metastases were identified, which were resistant to targeted therapies. The patient died 12 months postpartum. CONCLUSION: Although renal tumours during pregnancy have been reported, this is the first report of a fatal fast-growing renal tumour.
Subject(s)
Carcinoma, Renal Cell/secondary , Kidney Neoplasms/pathology , Pregnancy Complications, Neoplastic/pathology , Adult , Bone Neoplasms/secondary , Brain Neoplasms/secondary , Carcinoma, Renal Cell/surgery , Fatal Outcome , Female , Humans , Kidney Neoplasms/surgery , Liver Neoplasms/secondary , Lung Neoplasms/secondary , PregnancyABSTRACT
Nephrotic syndrome in a pregnant woman may be challenging, especially when the onset is early in pregnancy or with severe manifestations. Preeclampsia is the most common cause of nephrotic syndrome in pregnancy; however, this review will focus on the management of other renal causes. The aim of this pragmatic review is to address clinical issues that clinicians looking after women with nephrotic syndrome may encounter during pregnancy and the postpartum period. First, we discuss some general issues regarding nephrotic syndrome and its impact on maternal and fetal outcomes in pregnancy, and then we review the maternal management of nephrotic syndrome in pregnancy and during the postpartum period.
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INTRODUCTION: Venous thromboembolism (VTE) is one of the leading causes of maternal mortality in the United States. Cesarean delivery is a known risk factor. This study was to determine the incidence of deep vein thrombosis (DVT) post cesarean delivery. MATERIALS AND METHODS: This was a prospective cohort study where two patients having undergone cesarean delivery each day were randomly selected. A lower extremity compression ultrasound was performed prior to hospital discharge. If no DVT was detected, participants were asked to return for a second ultrasound two weeks postpartum. Participants were also telephone-interviewed at three months for reported VTE. RESULTS: Of the 194 patients who consented to study participation, only one participant developed DVT after cesarean delivery, giving an overall incidence of 0.5% (95% CI, 0.1 to 2.8%). There were no DVT identified on the second ultrasound nor VTE reported 3 months postpartum. CONCLUSIONS: We found the DVT rate after cesarean delivery to be 0.5%.
Subject(s)
Cesarean Section/adverse effects , Postoperative Complications/etiology , Venous Thrombosis/etiology , Adolescent , Adult , Cohort Studies , Female , Humans , Postoperative Complications/diagnostic imaging , Postoperative Complications/epidemiology , Pregnancy , Prospective Studies , Puerperal Disorders/diagnostic imaging , Puerperal Disorders/epidemiology , Puerperal Disorders/etiology , Risk Factors , Ultrasonography , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/epidemiology , Young AdultABSTRACT
OBJECTIVE: This study was undertaken to evaluate whether or not an educational pamphlet could improve knowledge without increasing anxiety in women with preeclampsia. METHODS: One hundred women recruited from an inpatient setting with suspected or proven preeclampsia were asked to answer a questionnaire assessing demographics, knowledge (primary outcome), anxiety and satisfaction (secondary outcomes) after being randomized to an intervention group (who received a pamphlet) or a control group (who did not received a pamphlet). The pamphlet and questionnaire, both designed by a multidisciplinary team, were read and answered at the same time. RESULTS: Baseline and demographic characteristics were similar between the two groups. Knowledge about the symptoms of pre-eclampsia was excellent in both groups (61% to 100% correct answers). Women in both groups were well aware that preeclampsia in the past (P = 0.22) and a family history of preeclampsia (P = 0.57) were risk factors. There was a significant difference in knowledge about the risk of some fetal complications, including death (90% versus 39%, P < 0.01) and all maternal complications (P < 0.05) favouring the intervention group. Despite increased knowledge about preeclampsia and its risks, anxiety was not greater in the intervention group. Overall, there was a trend towards less knowledge in vulnerable subgroups (non-white, low income and schooling levels), but the improvement of knowledge with the pamphlet was equivalent. Baseline anxiety was higher in the vulnerable groups, but was generally not increased by the pamphlet. CONCLUSION: An educational pamphlet for women with suspected preeclampsia was able to increase knowledge without increasing anxiety.