Chamrutha, R (2022) A Study of Thromboembolic Disorders Complicating Pregnancy and Puerperium and Its Maternal and Fetal Outcomes: Prospective Observational study in a Tertiary Care Centre. Masters thesis, Thanjavur Medical College, Thanjavur.
|
Text
220600522chamrutha.pdf Download (4MB) | Preview |
Abstract
Important clinical signs to suggest Thromboembolic disorder are wide. ❖ Thromboembolism is one of the most serious complications of puerperium and it is a recognized rising cause for maternal mortality. ❖ Though hypercoagulable state of pregnancy creates the risk, it is possible to prevent cerebral venous thrombosis by timely identification and correction of risk factors. Important risk factors are anaemia, preeclampsia, infection and dehydration. According to the study, ⦿ Highest incidence of Thromboembolic disorders was observed in age group 26-35 years. ⦿ Maximum number of thromboembolic disorder occurred in Multiparous women. ⦿ Majority of women with thromboembolic disorder are overweight contributing to 42%,followed by obesity 16% ⦿ Incidence of postpartum thromboembolism was highest in first week of postpartum with 73.3%. ⦿ Out of 100 patients, 54% of the patients are moderate anaemia, 19% of patients are with severe anaemia. ⦿ The commonest risk factor noted was hypertensive disorders of pregnancy 54%. ⦿ Puerperium forms important causes of thromboembolic disorder. ⦿ Headache was the most common symptom followed by convulsions in CVT group. ⦿ Radiologically most common sinus involved in CVT was superior sagittal sinus 55.7%. ⦿ In postpartum cerebral venous thrombosis Superior sagital sinus was most commonly involved. ⦿ Management with Unfractionated heparin/injection Low molecular weight heparin followed by oral anticoagulants is appropriate and the prognosis is generally favourable. CONCLUSION: ❖ The risk factors should be corrected accordingly like anaemia with blood transfusion, BP monitoring, early mobilisation in the puerperal period, dehydrated patients with Intravenous fluids. ❖ The risks of thromboembolism (0.05 Vs. 12%) are higher in incidence as compared to non-obese. ❖ During every antenatal visits, weight & B. P. recording with appropriate sized cuff. Obese women should be evaluated for gestation diabetes at 1st visit. Testing should be repeated in second & third trimester if previous findings were normal. ❖ Women with severe obesity(BMI>35kg/m2) with one additional risk factor for hypertensive disease should be prescribed Aspirin 75mg per day from 12 weeks of gestation in order to prevent further risks of thromboembolism. ❖ Heparin is restarted 4-6 hours after normal delivery and 24 hours after caesarean section. Oral anticoagulants can be started concomitantly. Breast feeding is not contraindicated. Patient should be encouraged to ambulate early and is discharged after a week if stable. Appropriate contraceptive advice should be given before the woman is discharged. ❖ Thromboprophylaxis in Peripartum Period x Anticoagulation to be stopped before elective LSCS and labor. UFH to be stopped 12 hours prior, LMWH 24 hours prior x Platelet count should be done with UFH therapy x For epidural analgesia last dose of prophylactic LMWH should not be earlier than 12 hours and 6 hours for UFH x UFH has shorter half-life, hence managing in labor is easier. So some people stop LMWH at 36 weeks and convert on UFH x Anticoagulation to be restarted 4–6 hours after normal delivery, 6–12 hours after LSCS x All patients on anticoagulations should be warned regarding vaginal bleeding. Baseline a PTT and platelet count should be done. Protamine sulfate should be ready. Fresh frozen plasma should be ready. Post-Partum Haemorrhage should be avoided. ❖ Thromboprophylaxis in Peripartum Period x Anticoagulation to be stopped before elective LSCS and labor. UFH to be stopped 12 hours prior, LMWH 24 hours prior x Platelet count should be done with UFH therapy x For epidural analgesia last dose of prophylactic LMWH should not be earlier than 12 hours and 6 hours for UFH x UFH has shorter half-life, hence managing in labor is easier. So some people stop LMWH at 36 weeks and convert on UFH x Anticoagulation to be restarted 4–6 hours after normal delivery, 6–12 hours after LSCS x All patients on anticoagulations should be warned regarding vaginal bleeding. Baseline a PTT and platelet count should be done. Protamine sulfate should be ready. Fresh frozen plasma should be ready. PPH should be avoided. ❖ On confirmation of thromboembolism, the following treatment is started: o Admission and monitoring in High dependency unit o Supportive treatment in form of hydration, analgesics and antibiotics o High quality graduated elastic compression stockings should be given for patients with DVT. ❖ Risk factors like anaemia, pre eclampsia, infection and dehydration should be identified at the level of Primary health care systems itself. ❖ Identification of risk factors and recommendations for thrombo prophylaxis should be considered. Early diagnosis and initiation of treatment reduces the mortality.
| Item Type: | Thesis (Masters) |
|---|---|
| Additional Information: | 221816202 |
| Uncontrolled Keywords: | Thromboembolic Disorders, Complicating Pregnancy, Puerperium, Maternal and Fetal Outcomes. |
| Subjects: | MEDICAL > Obstetrics and Gynaecology > MEDICAL > Obstetrics and Gynaecology |
| Depositing User: | Subramani R |
| Date Deposited: | 15 May 2021 12:59 |
| Last Modified: | 03 Dec 2023 13:14 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/16744 |
Actions (login required)
 |
View Item |
