Venous thromboembolism (VTE) is the leading cause of maternal mortality in the U.S. Cesarean delivery (CD) increases the risk of VTE. There are no specific guidelines for thromboprophylaxis after CD. This study was designed to determine the prevalence of deep vein thrombosis (DVT) in this population.
This was a prospective cohort study of 194 patients randomly selected after having undergone CD. Exclusion criteria: <18 years old; received anticoagulation within 1 week of delivery; and history of VTE. Information was obtained through interviews and examinations. Participants underwent lower extremity compression ultrasound (US) prior to hospital discharge. If US was negative, a repeat outpatient US was arranged within 4 weeks postpartum. Participants were also interviewed to inquire about new VTE within 3–6 months postpartum.
Within the group of 194 participants, the rate of DVT was 0.5% (95% CI −0.5, 1.5). The mean age was 29.9 yr with a mean body mass index of 32.2 kg/m2. Ten percent of CD were emergency and 2% of participants received general anesthesia. Fifteen percent were on bedrest prior to delivery and 14% smoked during pregnancy. Other risk factors for VTE, such as preeclampsia, family history of VTE, and thrombophilia were low (<10%). Sixty-six percent of participants had leg swelling, 38% had leg pain and calf sizes were asymmetric by >=1 cm in 35% of participants.A second US was performed in 44% of participants and there were no DVT detected. There were no reported VTE per telephone interviews postpartum.CONCLUSIONS: Our findings suggest a low rate of DVT post CD of 5 per 1000. This rate is higher than the VTE rate in pregnancy and puerperium which is estimated to be 0.5 to 3 per 1000; however, it is not as high as that seen in the general surgical population. Physical signs and symptoms of DVT in postpartum women are unreliable.
Routine DVT prophylaxis for cesarean delivery in low risk population may not be justified.
W.W. Sia, None.