Department of Obstetrics & Gynaecology, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Hong Kong.
Department of Obstetrics & Gynaecology, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Hong Kong.
Taiwan J Obstet Gynecol. 2019 Jul;58(4):520-525. doi: 10.1016/j.tjog.2019.05.016.
Recommendations for venous thromboembolism (VTE) prophylaxis from authoritative guidelines for women undergoing caesarean delivery differed significantly and may not be applicable to Chinese populations. We aim to formulate a local risk model for VTE prophylaxis for caesarean section women.
A local risk score model based on demographic, obstetric and medical parameters was used to assess the risk of VTE in women undergoing caesarean delivery from May 2017 to April 2018 in a regional obstetric unit. Women with increased risk (VTE Score ≥ 2) are given mechanical prophylaxis with pneumatic cuff and those with high risk (VTE Score ≥ 3) are additionally prescribed low molecular weight heparin (LMWH) as pharmacological prophylaxis in the early postpartum period. The risk scores obtained by applying other major guidelines were then compared.
Of 859 patients were included for analysis, overweight (15.3%), advanced maternal age (9.7%), multiple pregnancy (5.1%), obesity (4.7%), and primary postpartum haemorrhage (4.1%) were the most common risk factors. Overall, 109 (12.7%) patients required mechanical prophylaxis and 28 (3.3%) patients required additional pharmacological prophylaxis. No patient had postpartum VTE events nor serious haemorrhage after receiving LMWH prophylaxis. In contrast, applying the Royal College of Obstetricians and Gynaecologists guidelines to our cohort, 649 (75.6%) patients would receive LMWH after caesarean section, compared with no patients under the American College of Obstetrics and Gynaecology guidelines.
Our local risk score model avoided the need for large proportions of women to be subjected to pharmacological prophylaxis, and appeared safe and practical.
来自权威性剖宫产指南的静脉血栓栓塞症（VTE）预防建议存在显著差异，可能不适用于中国人群。我们旨在为剖宫产女性制定一种当地的 VTE 预防风险模型。
使用基于人口统计学、产科和医学参数的本地风险评分模型，评估 2017 年 5 月至 2018 年 4 月在一个区域性产科单位接受剖宫产的女性发生 VTE 的风险。风险增加的女性（VTE 评分≥2）给予气动袖带机械预防，风险高的女性（VTE 评分≥3）在产后早期还需加用低分子肝素（LMWH）进行药物预防。然后比较应用其他主要指南获得的风险评分。
859 例患者纳入分析，超重（15.3%）、高龄产妇（9.7%）、多胎妊娠（5.1%）、肥胖（4.7%）和产后早期大出血（4.1%）是最常见的危险因素。总体而言，109 例（12.7%）患者需要机械预防，28 例（3.3%）患者需要额外的药物预防。接受 LMWH 预防后，没有患者发生产后 VTE 事件或严重出血。相比之下，将皇家妇产科医师学院指南应用于我们的队列，649 例（75.6%）患者在剖宫产术后需要接受 LMWH，而美国妇产科医师学院指南则没有患者需要接受。
我们的本地风险评分模型避免了大量女性需要接受药物预防，且似乎安全实用。
