妊娠期及产褥期静脉血栓栓塞症风险评估及预防

目的:评估妊娠期及产褥期女性的静脉血栓栓塞症(VTE)发生风险,明确风险因素,并予以针对性预防,为探索妊娠相关VTE风险评估及预防策略提供依据。方法:根据2015年英国皇家妇产科医师学会(RCOG)妊娠期及产褥期静脉血栓栓塞疾病诊治指南推荐量表,对2018年11月1日至2019年12月31日在首都医科大学附属北京妇产医院孕检分娩的2344例孕妇自早孕期进行妊娠及产褥期VTE风险评估。结果:2344例孕妇中,低危组(0~2分)2284例(97.44%),中危组(3分)44例(1.88%),高危组(4分及以上)16例(0.68%)。高危因素中前三位分别是年龄≥35岁(494例,21.08%),体外受精-胚胎移植术后(189例,8.06%)和卧床保胎≥3天(171例,7.30%)。研究队列中已分娩877例,对其进行产褥期VTE风险评估,低危组750例(85.22%),中危组84例(9.58%),高危组43例(4.90%),高危因素中前3位分别是择期剖宫产(214例,24.40%),年龄≥35岁(170例,19.38%)和体质量指数≥30kg/m2(144例,16.42%)。3例患者出现下肢深静脉血栓(发病率1.28‰),其中2例出现在妊娠期,1例出现在剖宫产术后。结论:我国孕产妇发生VTE的高危因素不同于西方国家,遗传因素少,高龄、卧床保胎、剖宫产术等高危因素多。按RCOG评分标准,产褥期VTE评分≥2分者占30.67%,因此完全参照国外指南标准是否适合我国人群尚需进一步研究确认。

Risk assessment and prophylaxis of venous thromboembolism in pregnancy and the puerperium

Objective:To evaluate the risk factors and targered prophylaxis of venous thromboembolism in pregnancy and the puerperium,and to provide evidence to devolpe assessment scale and prophylaxis in China.Methods:Used assessment scale according the guideline about venous thromboembolism in pregnancy and the puerperium authorized by Royal College of Obstetricians and Gynecologists in 2015,recruited pregnant women who want to get antenatal care and delivery their baby in Capital Medical University Beijing Obstetrics and Gynecology Hospital to fill in the assessment scale for venous thromboembolism from November 1st,2018 to December 31st,2019.Results:In 2344 pregnant women underwent risk assessment during early pregnancy,the low risk group(0~2 points),moderate risk group(3 points)and high risk group(≥4 points)were respectively 2284 cases(97.44%),44 cases(1.88%)and 16 cases(0.68%).The top three risk factors were age≥35 years(494 cases,21.08%),after in vitro fertilization and embryo transfer(189 cases,8.06%),and lie in bed≥3 days(171 cases,7.30%).In our study cohort,877 women had given birth and then fill in the assessment scale after delivery,postpartum assessment showed the groups of low risk,moderate risk and high risk were respectively 750 cases(85.22%),84 cases(9.58%),43 cases(4.90%).The top three risk factors were elective cesarean section(214 cases,24.40%),age≥35 years(170 cases,19.38%),and body mass index≥30kg/m2(144 cases,16.42%).Deep venous thrombosis of lower extremity occurred in 3 patients,2 during pregnancy and 1 after cesarean section.The incidence rate of deep venous thrombosis was 1.28‰.Conclusion:The results of our single center study showed that high risk factors of pregnant women in China are different from those in western countries.There are less genetic factors,more risk factors such as advanced age,bed-keeping,cesarean section,etc.According to RCOG scoring standard,VTE score≥2 points accounted for 30.67%in the puerperium in our study,therefore,further research is needed to confirm whether it is suitable for Chinese population to fully refer to the standard of foreign guidelines.