1
PREVALENCE OF THROMBOEMBOLISM IN PREGNANCY AND PUERPERIUM IN A TERTIARY CARE CENTER AND RISK FACTOR ASSESSMENT – A CROSS SECTIONAL STUDY
Dissertation submitted to
THE TAMILNADU DR. M.G.R. MEDICAL UNIVERSITY
In partial fulfillment of the regulations
For the award of the degree of
M.S. BRANCH-II
OBSTETRICS AND GYNECOLOGY
KILPAUK MEDICAL COLLEGE
CHENNAI
MAY 2020
2
BONAFIDE CERTIFICATE
This is to certify that the dissertation entitled “THROMBOEMBOLISM IN PREGNANCY AND PUERPERIUM IN A TERTIARY CARE CENTER – A CROSS SECTIONAL STUDY” is a bonafide record of work done by Dr. M. RAMYA GLORY in Kilpauk Medical college, Chennai during the period February 2019 to September 2019 under the guidance of Prof.Dr.K.L.MALARVIZHI, M.D.,DGO., DNB, Professor & Head of Obstetrics and Gynaecology, Government Kilpauk Medical College in partial fulfilment of requirement of MS degree in Obstetrics and Gynaecology degree examination of The Tamilnadu Dr. M.G.R Medical University to be held in May 2020.
Dr.K.L.MALARVIZHI,
MD.,DGO., DNBProf & HOD, Dept. Of Obstetrics &
Gynaecology, Government Kilpauk Medical College& Hospital,
Chennai – 600 010
Dr.P.VASANTHAMANI,
MD.,DGO.,MNAMS.,DCPSY.,MBA, THE DEAN,
Government Kilpauk Medical College&
Hospital,
Chennai – 600 010
3
DECLARATION
I Dr.M.RAMYA GLORY, Post graduate, Department of Obstetrics and Gynaecology, Government Kilpauk Medical college, solemnly declare that this dissertation entitled “THROMBOEMBOLISM IN PREGNANCY AND PUERPERIUM IN A TERTIARY CARE CENTER – A CROSS SECTIONAL STUDY” was done by me at Government Kilpauk Medical College during 2019-2020 under the guidance and supervision of Prof.Dr.K.L.MALARVIZHI, M.D.,DGO., DNB, Professor & Head
of Obstetrics and Gynaecology, Government Kilpauk Medical College. This dissertation is Submitted to the Tamil Nadu Dr. M.G.R. Medical University towards the partial fulfilment of requirements for the award of M.S. Degree in Obstetrics and Gynaecology (Branch-II).
Place: Chennai-10 Date: 9-Nov -2019
Dr.M.RAMYA GLORY, Postgraduate student,
Dept. Of Obstetrics & Gynaecology,
Govt. Kilpauk Medical College,
Chennai-10.
4
ACKNOWLEDGEMENT
I am thankful to our Dean Dr.P.VASANTHAMANI, M.D., DGO., MNAMS., DCPSY, MBA, Government Kilpauk Medical College, Chennai for allowing me to conduct the study and use the facilities and clinical materials available in the hospital.
It is my greatest pleasure to express my gratitude and thank Prof.Dr.K.L.MALARVIZHI, M.D.,DGO., DNB, Professor & Head, Department of Obstetrics and Gynaecology, Government Kilpauk Medical College& Hospital for her valuable guidance, interest, encouragement and the constructive ideas which she provided for this study.
I thank all my other Professors, Assistant Professors and paramedical Staffs of this Department of Obstetrics and Gynaceology, Kilpauk Medical College, Chennai-600010, without whom this would not have been possible.
I sincerely thank Dr.Padmanabhan, Ph.D, for his constant support during
this study and for his help in the statistical analysis of data and results.
5
I would like to thank all my fellow post graduates for helping me accomplish this.
I sincerely thank all my patients for their cooperation .
Last, but not the least, I thank my family and God Almighty for the
blessings showered onto me.
6
CONTENTS
1. INTRODUCTION 7
2. AIMS OF STUDY 9
3. REVIEW OF LITERATURE 11
4. MATERIALS AND METHODS 16
5. RESULTS 18
6. DISCUSSION 51
7. SUMMARY 56
8. CONCLUSION 57
9. BIBLIOGRAPHY 58
10. ANNEXURES 59
7
INTRODUCTION
Pregnancy and puerperium increases the risk of venous thromboembolism 4- to 5-fold over that in the nonpregnant state.
The manifestations of venous thromboembolism are 1. deep venous thrombosis and
2. pulmonary embolism.
Compared to non pregnant, pregnant women have a two and a half times increased risk of developing
thrombotic event and 20 fold risk in puerperium.
The incidence of pulmonary embolism is 7-8 times higher in puerperium.
Sequelae of DVT and PE include complications such as 1. pulmonary hypertension,
2. post-thrombotic syndrome, 3. and venous insufficiency.
Incidence is estimated to be between 0.08 and 1.2 percent following vaginal delivery and
3.0 percent following caesarean section.
There is no surveillance for thromboembolism, so the number of people affected by it is not known. Based on analysis of clinical studies, the overall annual incidence is estimated to be between 1 and 2 per 1000 of the population.
These incidence rates differ by age, race, and gender .
The incidence ranges from 1 per 100,000 in the young and increases to about 1
per 100 in people aged ≥80 years.
8
The overall rate is higher among blacks and whites than among other races.
Men have a slightly higher overall incidence rate than women, but women have a slight increase during the reproductive years.
Because of the difficulty in documenting DVT and PE, VTE may be under- reported.
Morbidity and Mortality
Venous thromboembolism is often fatal. Depending on,reports estimate that 10%–30% of patients had mortality within 30 days; the majority of deaths occur among those with PE, as an estimated 20%–25% of all PE cases present as sudden death.
Other serious complications of DVT and PE include increased risks of recurrent thromboembolism and chronic morbidity
Even after a standard course of anticoagulant therapy,1/3
rdof previous thromboembolism patients have recurrence within 10 years of the primary event,with risk remaining in the rest of their life.
Half of DVT patients develop post-thrombotic syndrome and chronic venous insufficiency, conditions characterized by pain, swelling, skin necrosis, and ulceration.,
If on life long anticoagulation,they are at increased risk of bleeding tendencies.
9
AIM OF THE STUDY
STUDY OF PREVALENCE OF THROMBOEMBOLISM IN PREGNANCY AND PUERPERIUM In A TERTIARY CARE CENTER AND RISK FACTOR ASSESSMENT – A CROSS SECTIONAL STUDY
OBJECTIVES:
The purpose of this study is to estimate the prevalence of Thromboembolism in Pregnancy and Puerperium,assessment of risk factors,need for
anticoagulants,maternal and fetal outcome in a Teritiary Care Center in Govt.
Kilpauk Medical College, Chennai
10
11
REVIEW OF LITERATURE
Pregnancy increases the risk of venous thromboembolism 4- to 5-fold over that in the nonpregnant state.
The two manifestations of VTE are 1.deep venous thrombosis and 2. pulmonary embolus .
Venous thromboembolism can occur at any trimester in pregnancy,but more common during the first half of pregnancy .
Deep vein thrombosis is a blood clot that develops in the leg, thigh, or pelvis. Pregnant women are more prone for thrombus since it is
hypercoagulable state.
The level of blood-clotting proteins increases during pregnancy, while
anticlotting protein levels decrease. The gravid uterus also compresses the venacavae
symptoms
1.swelling and heavy pain
2. extreme tenderness in one of the legs.
pain in the leg while walking
pain in the leg that become severe when you bend your foot
warmness and redness of skin
Pulmonary embolism
Symptoms include:
sudden shortness of breath
12
chest pain
blood-streaked sputum
tachycardia
Factors affecting thrombosis in pregnancy
1.increased fibrinogen,factors II,V,VII,VIII,X
2.Decreased protein c,s,Increase in protein c resistance.
Risk factors
Factors that increase your risk for DVT during pregnancy are:
previous history of DVT
family history of DVT
age over 35 years
BMI of 30 or more
Multiple pregnancy
History of fertility treatment
previous, cesarean delivery
period of prolonged immovability
smoking
preclampsia, or certain chronic illnesses such as hypertension .
severe varicose veins
13
Diagnosis
Compression duplex ultrasonography –Primary Diagnostic Test (Positive if non- compressible and evidence of Hypo echoic mass lesion )
Start anticoagulants treatment
If ultrasound is negative but clinically suspicious of thrombus
Anticoagulants stopped
Repeat ultrasound after 3 days
If again negative-no need any treatment
If positive ,start anticoagulants
OTHER INVESTIGATIONS:
1.X-RAY CHEST-wedge shaped opacities ,FOCAL OLIGEMIA,westermarks sign
2.ECG-T wave inversion,S1Q3T3 pattern AND RIGHT BUNDLE BRANCH BLOCK
3.CTPA(CT Pulmonary angiography) –in preference to V/Q(VENTILATION
PERFUSION SCAN)
14
If confirmed By CTPA –start anticoagulants.
4.D-Dimer test and coagulation profile.
Treatment
Start on anticoagulants,check with coagulation profile
Effects on the baby
No complications to baby
Heparin is safe during pregnancy since ti will not cross placenta.
Heparin stopped as soon as labor starts or 24 hours prior to induction of labour/electine caesarean section.
In postnatal period stop heparin incse of breast feeding,switch over to warfarin.
PREVENTION
Active life with safe exercise
Stop smoking
Managemen t
Two main options are
15
LMWH or Warfarin-
treatment should be continued for 6 weeks postpartum or minimum of 3 months
Key points
Venous thromboembolism in pregnancy is a leading and direct cause of maternal mortality.
Venous thromboembolism is 10-times more common in the pregnant population with an incidence of 1 in 1000 and highest risk in the PUERPERIUM
In case of suspicious pulmonary embolism, ventilation perfusion scanning is the initial test in pregnancy.
treatment should be continued for 6 weeks postpartum or minimum of 3 months
LMWH is safe, effective and has a low associated bleeding
risk.
16
MATERIALS AND METHODS
STUDY DESIGN : PROSPECTIVE RANDOMISED CONTROL STUDY.
PERIOD OF STUDY:-FEBRUARY 2019-SEPTEMBER 2019
PLACE OF STUDY:- Obstetrics & Gynaecology ,Govt Kilpauk Medical College, Chennai.
STUDY POPULATION:- Antenatal and Postnatal patients getting admitted in O & G dept. Govt. Kilpauk Medical College, Chennai.
SAMPLE SIZE:- Determined by statistical analysis. Statistical analysis was done using chi square test in appropriate places. About 200 women were randomized to study on Thromboembolism.
1.96*1.96*0.30*0.70/(0.03*0.03)=0.806736/0.06*0.06 Zα/22 *P*(1-P)/d2,
Alpha error=5%,95% confidence limits
P=0.40 O=0.60(1-P) D=20% of P—6 Sample size is 200
Inclusion criteria:-
1. Patient who are having signs and symptoms of Venous Thromboembolism 2. Antenatal risk factors like age > 35, Obesity, Multipara(>3), BMI more than 30, Intra Uterine Death, Abruption, Anemia, Pre-eclampsia, Gross Varicose veins, prolonged immobility, medical comorbidities, thrombophilias.
3. Postnatal risk factors like ceasarean section, operative vaginal
deliveries,prolonged surgeries.
17
18
Exclusion criteria:-
Previous history of venous Thromboembolism Valvular heart diseases
METHODOLOGY
The patients who are diagnosed as having signs and symptoms of Venous Thromboembolism ,having risk factors are taken as study group.
Patients will be tested for the following 1.coagulation profile
2.Chest Xray in postnatal mothers
3.Colour Doppler study of lowerlimb veins 4.CT and Pulmonary Angiography
11) Study Proforma (attached)
12) Consent form (attached)
13) Approval by ethical committee and its composition (attached)
14) Approval by scientific committee and its composition (attached)
19
RESULTS
AGE GROUP * GROUP
AGE GROUP * Thromboembolism
Crosstab
Thromboembolism
Total
NO YES
AGE GROUP 1 Count 43 8 51
% within Thromboembolism 23.8% 42.1% 25.5%
% of Total 21.5% 4.0% 25.5%
2 Count 138 11 149
% within Thromboembolism 76.2% 57.9% 74.5%
% of Total 69.0% 5.5% 74.5%
Total Count 181 19 200
% within Thromboembolism 100.0% 100.0% 100.0%
% of Total 90.5% 9.5% 100.0%
Chi-Square Tests
Value df
Asymptotic Significance (2-
sided)
Exact Sig. (2- sided)
Exact Sig. (1- sided)
Pearson Chi-Square 3.047a 1 .081
Continuity Correctionb 2.158 1 .142
Likelihood Ratio 2.770 1 .096
Fisher's Exact Test .098 .075
Linear-by-Linear Association 3.032 1 .082
N of Valid Cases 200
a. 1 cells (25.0%) have expected count less than 5. The minimum expected count is 4.85.
b. Computed only for a 2x2 table
20
CHI SQUARED= 3.047 P= 0.081 NOT SIGNIFICANT.
In both the groups less than 10% observed in both age group, 8(4%) in 18-21 age group and 11(5.5%) in 22-25 age group.
No statistically significant differences in age distribution of patients assigned to the 2 groups
BMI GROUP * Thromboembolism
Crosstab
Thromboembolism
Total
NO YES
BMI GROUP 1 Count 40 0 40
% within Thromboembolism 22.1% 0.0% 20.0%
% of Total 20.0% 0.0% 20.0%
2 Count 117 19 136
% within Thromboembolism 64.6% 100.0% 68.0%
21
% of Total 58.5% 9.5% 68.0%
3 Count 24 0 24
% within Thromboembolism 13.3% 0.0% 12.0%
% of Total 12.0% 0.0% 12.0%
Total Count 181 19 200
% within Thromboembolism 100.0% 100.0% 100.0%
% of Total 90.5% 9.5% 100.0%
Chi-Square Tests
Value df
Asymptotic Significance (2-
sided)
Pearson Chi-Square 9.880a 2 .004
Likelihood Ratio 15.578 2 .000
Linear-by-Linear Association .426 1 .514
N of Valid Cases 200
a. 2 cells (33.3%) have expected count less than 5. The minimum expected count is 2.28.
CHI SQUARED= 9.880 P= 0.007 SIGNIFICANT.
22
In 3 groups less than 10% observed in 3 BMI groups, 0(0%) in BMI group, 19(9.5%) in BMI group2 and 0(0%) in BMI group3.
Statistically significant differences in in distribution of patients assigned to 2
ndgroup with other groups
GRAVIDA * Thromboembolism
Crosstab
Thromboembolism
Total
NO YES
GRAVIDA 1 Count 125 11 136
% within Thromboembolism 69.1% 57.9% 68.0%
% of Total 62.5% 5.5% 68.0%
2 Count 48 0 48
% within Thromboembolism 26.5% 0.0% 24.0%
% of Total 24.0% 0.0% 24.0%
3 Count 8 8 16
% within Thromboembolism 4.4% 42.1% 8.0%
% of Total 4.0% 4.0% 8.0%
Total Count 181 19 200
% within Thromboembolism 100.0% 100.0% 100.0%
% of Total 90.5% 9.5% 100.0%
Chi-Square Tests
Value df
Asymptotic Significance (2-
sided)
Pearson Chi-Square 35.879a 2 .000
Likelihood Ratio 26.992 2 .000
Linear-by-Linear Association 10.208 1 .001
N of Valid Cases 200
a. 2 cells (33.3%) have expected count less than 5. The minimum expected count is 1.52.
23
CHI SQUARED= 35.879 P= 0.000 SIGNIFICANT.
In 3 groups less than 10% observed in 1 and 3 GRAVIDA groups, 11(5.5%) in GRAVIDA group, 0(0%) in GRAVIDA group2 and 8(4%) in GRAVIDA group3.
Statistically significant differences in distribution of patients assigned to the 1 and 3 groups
PARA * Thromboembolism
Crosstab
Thromboembolism
Total
NO YES
PARA 0 Count 133 11 144
% within Thromboembolism 73.5% 57.9% 72.0%
% of Total 66.5% 5.5% 72.0%
1 Count 40 0 40
% within Thromboembolism 22.1% 0.0% 20.0%
% of Total 20.0% 0.0% 20.0%
2 Count 8 8 16
24
% within Thromboembolism 4.4% 42.1% 8.0%
% of Total 4.0% 4.0% 8.0%
Total Count 181 19 200
% within Thromboembolism 100.0% 100.0% 100.0%
% of Total 90.5% 9.5% 100.0%
Chi-Square Tests
Value df
Asymptotic Significance (2-
sided)
Pearson Chi-Square 35.304a 2 .000
Likelihood Ratio 25.682 2 .000
Linear-by-Linear Association 12.437 1 .000
N of Valid Cases 200
a. 2 cells (33.3%) have expected count less than 5. The minimum expected count is 1.52.
CHI SQUARED= 35.304 P= 0.000 NOT SIGNIFICANT.
In 3 groups less than 10% observed in 3 PARA groups, 11(5.5%) in GRAVIDA group, 0(0%) in PARA group2 and 8(4%) in PARA group3.
25
Statistically significant differences in distribution of patients assigned to the 1 and 3 Para groups
LIVE * Thromboembolism
Crosstab
Thromboembolism
Total
NO YES
LIVE 0 Count 141 11 152
% within Thromboembolism 77.9% 57.9% 76.0%
% of Total 70.5% 5.5% 76.0%
1 Count 32 0 32
% within Thromboembolism 17.7% 0.0% 16.0%
% of Total 16.0% 0.0% 16.0%
2 Count 8 8 16
% within Thromboembolism 4.4% 42.1% 8.0%
% of Total 4.0% 4.0% 8.0%
Total Count 181 19 200
% within Thromboembolism 100.0% 100.0% 100.0%
% of Total 90.5% 9.5% 100.0%
Chi-Square Tests
Value df
Asymptotic Significance (2-
sided)
Pearson Chi-Square 34.790a 2 .000
Likelihood Ratio 24.446 2 .000
Linear-by-Linear Association 15.080 1 .000
N of Valid Cases 200
a. 2 cells (33.3%) have expected count less than 5. The minimum expected count is 1.52.
26
CHI SQUARED= 34.790 P= 0.000 SIGNIFICANT.
In 3 groups less than 10% observed in 3 LIVE groups, 11(5.5%) in group1, 0(0%) in LIVE group2 and 8(4%) in group3.
Statistically significant differences in distribution of patients assigned to the 3 groups
ABORTIO * Thromboembolism
Crosstab
Thromboembolism
Total
NO YES
ABORTIO 0 Count 173 19 192
% within Thromboembolism 95.6% 100.0% 96.0%
% of Total 86.5% 9.5% 96.0%
1 Count 8 0 8
% within Thromboembolism 4.4% 0.0% 4.0%
% of Total 4.0% 0.0% 4.0%
Total Count 181 19 200
% within Thromboembolism 100.0% 100.0% 100.0%
% of Total 90.5% 9.5% 100.0%
27
Chi-Square Tests
Value df
Asymptotic Significance (2-
sided)
Exact Sig. (2- sided)
Exact Sig. (1- sided)
Pearson Chi-Square .875a 1 .350
Continuity Correctionb .102 1 .749
Likelihood Ratio 1.632 1 .201
Fisher's Exact Test 1.000 .443
Linear-by-Linear Association .870 1 .351
N of Valid Cases 200
a. 1 cells (25.0%) have expected count less than 5. The minimum expected count is .76.
b. Computed only for a 2x2 table
CHI SQUARED= 0.875 P= 0.350 NOT SIGNIFICANT.
In 2 groups less than 10% observed in 2 Abortion groups, 19(9.5%) in group1 , 0(0%) in group2 .
No statistically significant differences in distribution of patients assigned to
the 2 groups
28
H/SURGERY * Thromboembolism
Crosstab
Thromboembolism
Total
NO YES
H/SURGERY 0 Count 178 9 187
% within Thromboembolism 98.3% 47.4% 93.5%
% of Total 89.0% 4.5% 93.5%
1 Count 3 10 13
% within Thromboembolism 1.7% 52.6% 6.5%
% of Total 1.5% 5.0% 6.5%
Total Count 181 19 200
% within Thromboembolism 100.0% 100.0% 100.0%
% of Total 90.5% 9.5% 100.0%
Chi-Square Tests
Value df
Asymptotic Significance (2-
sided)
Exact Sig. (2- sided)
Exact Sig. (1- sided)
Pearson Chi-Square 73.515a 1 .000
Continuity Correctionb 65.367 1 .000
Likelihood Ratio 39.367 1 .000
Fisher's Exact Test .000 .000
Linear-by-Linear Association 73.148 1 .000
N of Valid Cases 200
a. 1 cells (25.0%) have expected count less than 5. The minimum expected count is 1.24.
b. Computed only for a 2x2 table
29
CHI SQUARED= 73.515 P= 0.000 SIGNIFICANT.
In 2 groups less than 10% observed in 2 H/Surgery groups, 9(4.5%) in group, 10(5%) in group2.
Statistically significant differences in distribution of patients assigned to the 2 groups
IMMOVABILITY * Thromboembolism
Crosstab
Thromboembolism
Total
NO YES
IMMOVABILITY 0 Count 178 11 189
% within Thromboembolism 98.3% 57.9% 94.5%
% of Total 89.0% 5.5% 94.5%
1 Count 3 8 11
% within Thromboembolism 1.7% 42.1% 5.5%
% of Total 1.5% 4.0% 5.5%
Total Count 181 19 200
% within Thromboembolism 100.0% 100.0% 100.0%
% of Total 90.5% 9.5% 100.0%
30
Chi-Square Tests
Value df
Asymptotic Significance (2-
sided)
Exact Sig. (2- sided)
Exact Sig. (1- sided)
Pearson Chi-Square 54.125a 1 .000
Continuity Correctionb 46.623 1 .000
Likelihood Ratio 28.780 1 .000
Fisher's Exact Test .000 .000
Linear-by-Linear Association 53.854 1 .000
N of Valid Cases 200
a. 1 cells (25.0%) have expected count less than 5. The minimum expected count is 1.05.
b. Computed only for a 2x2 table
CHI SQUARED= 54.125 P= 0.000 SIGNIFICANT.
In 2 groups less than 10% observed in 2 IMMOVABILITY groups, 11(5.5%) in group and 8(4%) in group2.
Statistically significant differences in distribution of patients assigned to the 2
groups
31
VARICOSE VEIN * Thromboembolism
Crosstab
Thromboembolism
Total
NO YES
VERICOSE VEIN 0 Count 181 11 192
% within Thromboembolism 100.0% 57.9% 96.0%
% of Total 90.5% 5.5% 96.0%
1 Count 0 8 8
% within Thromboembolism 0.0% 42.1% 4.0%
% of Total 0.0% 4.0% 4.0%
Total Count 181 19 200
% within Thromboembolism 100.0% 100.0% 100.0%
% of Total 90.5% 9.5% 100.0%
Chi-Square Tests
Value df
Asymptotic Significance (2-
sided)
Exact Sig. (2- sided)
Exact Sig. (1- sided)
Pearson Chi-Square 79.386a 1 .000
Continuity Correctionb 68.800 1 .000
Likelihood Ratio 41.314 1 .000
Fisher's Exact Test .000 .000
Linear-by-Linear Association 78.989 1 .000
N of Valid Cases 200
a. 1 cells (25.0%) have expected count less than 5. The minimum expected count is .76.
b. Computed only for a 2x2 table
32
CHI SQUARED= 79.386 P= 0.000 SIGNIFICANT.
In 2 groups less than 10% observed in 2 Varicose groups, 11(5.5%) in group 1, 8(4%) in group2.
Statistically significant differences in distribution of patients assigned to the 2 groups
GHT * Thromboembolism
Crosstab
Thromboembolism
Total
NO YES
GHT 0 Count 165 11 176
% within Thromboembolism 91.2% 57.9% 88.0%
% of Total 82.5% 5.5% 88.0%
1 Count 16 8 24
% within Thromboembolism 8.8% 42.1% 12.0%
% of Total 8.0% 4.0% 12.0%
Total Count 181 19 200
% within Thromboembolism 100.0% 100.0% 100.0%
33
% of Total 90.5% 9.5% 100.0%
Chi-Square Tests
Value df
Asymptotic Significance (2-
sided)
Exact Sig. (2- sided)
Exact Sig. (1- sided)
Pearson Chi-Square 18.019a 1 .000
Continuity Correctionb 15.006 1 .000
Likelihood Ratio 12.735 1 .000
Fisher's Exact Test .000 .000
Linear-by-Linear Association 17.929 1 .000
N of Valid Cases 200
a. 1 cells (25.0%) have expected count less than 5. The minimum expected count is 2.28.
b. Computed only for a 2x2 table
CHI SQUARED= 18.019 P= 0.000 SIGNIFICANT.
In 2 groups less than 10% observed in 2 GHT groups, 11(5.5%) in group 1, 8(4%) in group2.
Statistically significant differences in distribution of patients assigned to the 2 groups
34
ANEMIA * Thromboembolism
Crosstab
Thromboembolism
Total
NO YES
ANEMIA 0 Count 152 0 152
% within Thromboembolism 87.0% 0.0% 76.0%
% of Total 76.0% 0.0% 76.0%
1 mild
Count 21 19 40
% within Thromboembolism 11.6% 100.0% 20.0%
% of Total 10.5% 9.5% 20.0%
2 Count 2 6 8
severe
% within Thromboembolism 1.0% 24.0% 4.0%
% of Total 1.0% 3.0% 4.0%
Total Count 175 25 200
% within Thromboembolism 100.0% 100.0% 100.0%
% of Total 90.5% 9.5% 100.0%
Chi-Square Tests
Value df
Asymptotic Significance (2-
sided)
Exact Sig. (2- sided)
Exact Sig. (1- sided)
Pearson Chi-Square 83.978a 1 .000
Continuity Correctionb 78.544 1 .000
Likelihood Ratio 70.231 1 .000
Fisher's Exact Test .000 .000
Linear-by-Linear Association 83.558 1 .000
N of Valid Cases 200
a. 1 cells (25.0%) have expected count less than 5. The minimum expected count is 3.80.
b. Computed only for a 2x2 table
35
ANEMIA
CHI SQUARED= 83.978 P= 0.000 SIGNIFICANT.
In 3 groups risk of thromboembolism is present in anemia.
Statistically significant differences in distribution of patients assigned to the 3 groups.but no statistical significance between mild and severe.
NICU * Thromboembolism
Crosstab
Thromboembolism
Total
NO YES
NICU 0 Count 69 11 80
% within Thromboembolism 38.1% 57.9% 40.0%
% of Total 34.5% 5.5% 40.0%
1 Count 112 8 120
% within Thromboembolism 61.9% 42.1% 60.0%
% of Total 56.0% 4.0% 60.0%
Total Count 181 19 200
% within Thromboembolism 100.0% 100.0% 100.0%
% of Total 90.5% 9.5% 100.0%
36
Chi-Square Tests
Value df
Asymptotic Significance (2-
sided)
Exact Sig. (2- sided)
Exact Sig. (1- sided)
Pearson Chi-Square 2.801a 1 .094
Continuity Correctionb 2.038 1 .153
Likelihood Ratio 2.735 1 .098
Fisher's Exact Test .138 .078
Linear-by-Linear Association 2.787 1 .095
N of Valid Cases 200
a. 0 cells (0.0%) have expected count less than 5. The minimum expected count is 7.60.
b. Computed only for a 2x2 table
CHI SQUARED= 2.801 P= 0.094 not SIGNIFICANT.
In 2 groups less than 10% observed in 2 NICU groups, 11(5.5%) in group 1, 8(4%) in group2.
No statistically significant differences in distribution of patients assigned to
the 2 groups
37
RD * Thromboembolism
Crosstab
Thromboembolism
Total
NO YES
RD 0 Count 69 11 80
% within Thromboembolism 38.1% 57.9% 40.0%
% of Total 34.5% 5.5% 40.0%
1 Count 112 8 120
% within Thromboembolism 61.9% 42.1% 60.0%
% of Total 56.0% 4.0% 60.0%
Total Count 181 19 200
% within Thromboembolism 100.0% 100.0% 100.0%
% of Total 90.5% 9.5% 100.0%
Chi-Square Tests
Value df
Asymptotic Significance (2-
sided)
Exact Sig. (2- sided)
Exact Sig. (1- sided)
Pearson Chi-Square 2.801a 1 .094
Continuity Correctionb 2.038 1 .153
Likelihood Ratio 2.735 1 .098
Fisher's Exact Test .138 .078
Linear-by-Linear Association 2.787 1 .095
N of Valid Cases 200
a. 0 cells (0.0%) have expected count less than 5. The minimum expected count is 7.60.
b. Computed only for a 2x2 table
38
CHI SQUARED= 2.801 P= 0.094 not SIGNIFICANT.
In 2 groups less than 10% observed in 2 RD groups, 11(5.5%) in group 1, 8(4%) in group2.
No statistically significant differences in distribution of patients assigned to the 2 groups
FET INFEC * Thromboembolism
Crosstab
Thromboembolism
Total
NO YES
FET INFEC 0 Count 173 19 192
% within Thromboembolism 95.6% 100.0% 96.0%
% of Total 86.5% 9.5% 96.0%
1 Count 8 0 8
% within Thromboembolism 4.4% 0.0% 4.0%
% of Total 4.0% 0.0% 4.0%
Total Count 181 19 200
% within Thromboembolism 100.0% 100.0% 100.0%
% of Total 90.5% 9.5% 100.0%
39
Chi-Square Tests
Value df
Asymptotic Significance (2-
sided)
Exact Sig. (2- sided)
Exact Sig. (1- sided)
Pearson Chi-Square .875a 1 .350
Continuity Correctionb .102 1 .749
Likelihood Ratio 1.632 1 .201
Fisher's Exact Test 1.000 .443
Linear-by-Linear Association .870 1 .351
N of Valid Cases 200
a. 1 cells (25.0%) have expected count less than 5. The minimum expected count is .76.
b. Computed only for a 2x2 table
CHI SQUARED= 0.875 P= 0.350 not SIGNIFICANT.
In 2 groups less than 10% observed in 2 groups, 19(9.5%) in group 1, 0(0%)in group2.
No statistically significant differences in distribution of patients assigned to
the 2 groups
40
DEATH * Thromboembolism
Crosstab
Thromboembolism
Total
NO YES
DEATH 0 Count 165 19 184
% within Thromboembolism 91.2% 100.0% 92.0%
% of Total 82.5% 9.5% 92.0%
1 Count 16 0 16
% within Thromboembolism 8.8% 0.0% 8.0%
% of Total 8.0% 0.0% 8.0%
Total Count 181 19 200
% within Thromboembolism 100.0% 100.0% 100.0%
% of Total 90.5% 9.5% 100.0%
Chi-Square Tests
Value df
Asymptotic Significance (2-
sided)
Exact Sig. (2- sided)
Exact Sig. (1- sided)
Pearson Chi-Square 1.826a 1 .177
Continuity Correctionb .822 1 .365
Likelihood Ratio 3.337 1 .068
Fisher's Exact Test .373 .189
Linear-by-Linear Association 1.816 1 .178
N of Valid Cases 200
a. 1 cells (25.0%) have expected count less than 5. The minimum expected count is 1.52.
b. Computed only for a 2x2 table
41
CHI SQUARED= 1.826 P= 0.177 NOT SIGNIFICANT.
In 2 Death groups, 19(9.5%) in group1 and 0(0%) in group2 observed.
No statistically significant differences in distribution of patients assigned to the 2 groups
Frequency Table
GROUP
Frequency Percent Valid Percent
Cumulative Percent
Valid ANTENATAL 140 70.0 70.0 70.0
PUERPERIUM 60 30.0 30.0 100.0
Total 200 100.0 100.0
Case Processing Summary
Cases
Valid Missing Total
N Percent N Percent N Percent
GROUP *
THROMBOPHILIAS
200 100.0% 0 0.0% 200 100.0%
42
GHT * THROMBOPHILIAS 200 100.0% 0 0.0% 200 100.0%
ECLAMPSIA * THROMBOPHILIAS
200 100.0% 0 0.0% 200 100.0%
HEPARIN *
THROMBOPHILIAS
200 100.0% 0 0.0% 200 100.0%
GROUP *
Crosstab
THROMBOEMBOLISM
Total
NO YES
GROUP ANTENATAL Count 134 6 140
% within
THROMBOEMBOLISM
70.5% 60.0% 70.0%
PUERPERIUM Count 56 4 60
% within Thromboembolism 29.5% 40.0% 30.0%
Total Count 190 10 200
% within Thromboembolism 100.0% 100.0% 100.0%
Chi-Square Tests
Value df
Asymptotic Significance (2-
sided)
Exact Sig. (2- sided)
Exact Sig. (1- sided)
Pearson Chi-Square .501a 1 .479
Continuity Correctionb .125 1 .723
Likelihood Ratio .477 1 .490
Fisher's Exact Test .491 .348
Linear-by-Linear Association .499 1 .480
N of Valid Cases 200
a. 1 cells (25.0%) have expected count less than 5. The minimum expected count is 3.00.
b. Computed only for a 2x2 table
43
CHI SQUARED= 0.501 P= 0.479 NOT SIGNIFICANT.
In 2 groups, 6(60%) in group1 and 4(40%) in group2 observed.
No statistically significant differences in distribution of patients assigned to the 2 groups
Crosstab
Thromboembolism
Total
NO YES
APLA 0 Count 165 11 176
% within Thromboembolism 91.2% 57.9% 88.0%
% of Total 82.5% 5.5% 88.0%
1 Count 16 8 24
% within Thromboembolism 8.8% 42.1% 12.0%
% of Total 8.0% 4.0% 12.0%
Total Count 181 19 200
% within Thromboembolism 100.0% 100.0% 100.0%
% of Total 90.5% 9.5% 100.0%
Chi-Square Tests
Value df
Asymptotic Significance (2-
sided)
Exact Sig. (2- sided)
Exact Sig. (1- sided)
Pearson Chi-Square 18.019a 1 .000
44
Continuity Correctionb 15.006 1 .000
Likelihood Ratio 12.735 1 .000
Fisher's Exact Test .000 .000
Linear-by-Linear Association 17.929 1 .000
N of Valid Cases 200
a. 1 cells (25.0%) have expected count less than 5. The minimum expected count is 2.28.
b. Computed only for a 2x2 table
CHI SQUARED= 18.01 P= 0.000 SIGNIFICANT.
In 2 groups, 11(5.5%) in group1 and 8(4%) in group2 observed.
Statistically significant differences in distribution of patients assigned to the 2 groups
ECLAMPSIA
Frequency Percent Valid Percent
Cumulative Percent
Valid NO 197 98.5 98.5 98.5
YES 3 1.5 1.5 100.0
Total 200 100.0 100.0
Crosstab
Thromboembolism
Total
NO YES
ECLAMPSIA NO Count 188 9 197
45
% within Thromboembolism 98.9% 90.0% 98.5%
YES Count 2 1 3
% within Thromboembolism 1.1% 10.0% 1.5%
Total Count 190 10 200
% within Thromboembolism 100.0% 100.0% 100.0%
Chi-Square Tests
Value df
Asymptotic Significance (2-
sided)
Exact Sig. (2- sided)
Exact Sig. (1- sided)
Pearson Chi-Square 5.147a 1 .003
Continuity Correctionb .873 1 .350
Likelihood Ratio 2.457 1 .117
Fisher's Exact Test .143 .143
Linear-by-Linear Association 5.122 1 .024
N of Valid Cases 200
a. 2 cells (50.0%) have expected count less than 5. The minimum expected count is .15.
b. Computed only for a 2x2 table
CHI SQUARED= 5.147 P= 0.023 SIGNIFICANT.
In 2 groups, 9(90%) in group1 and 1(10%) in group2 observed.
statistically significant differences in distribution of patients assigned to the
2 groups
46 HEPARIN
Frequency Percent Valid Percent
Cumulative Percent
Valid 0 168 84.0 84.0 84.0
1 32 16.0 16.0 100.0
Total 200 100.0 100.0
Crosstab
Thromboembolism
Total
NO YES
HEPARIN 0 Count 162 6 168
% within Thromboembolism 85.3% 60.0% 84.0%
1 Count 28 4 32
% within Thromboembolism 14.7% 40.0% 16.0%
Total Count 190 10 200
% within Thromboembolism 100.0% 100.0% 100.0%
Chi-Square Tests
Value df
Asymptotic Significance (2-
sided)
Exact Sig. (2- sided)
Exact Sig. (1- sided)
Pearson Chi-Square 4.511a 1 .034
Continuity Correctionb 2.827 1 .093
Likelihood Ratio 3.523 1 .061
Fisher's Exact Test .057 .057
Linear-by-Linear Association 4.489 1 .034
N of Valid Cases 200
a. 1 cells (25.0%) have expected count less than 5. The minimum expected count is 1.60.
b. Computed only for a 2x2 table
47
CHI SQUARED= 4.511 P= 0.034 NOT SIGNIFICANT.
In 2 groups, 6(60%) in group1 and 4(40%) in group2 observed.
No statistically significant differences in distribution of patients assigned to the 2 groups
Crosstab
Thromboembolism
Total
NO YES
NO Count 172 4 176
% within Thromboembolism 90.5% 40.0% 88.0%
MILD Count 15 4 19
% within Thromboembolism 7.9% 40.0% 9.5%
SEVERE Count 3 2 5
% within Thromboembolism 1.6% 20.0% 2.5%
Total Count 190 10 200
% within Thromboembolism 100.0% 100.0% 100.0%
Chi-Square Tests
Value df
Asymptotic Significance (2-
sided)
Pearson Chi-Square 25.958a 2 .000
Likelihood Ratio 14.937 2 .001
Linear-by-Linear Association 25.828 1 .000
N of Valid Cases 200
48
a. 3 cells (50.0%) have expected count less than 5. The minimum expected count is .25.
CHI SQUARED= 25.958 P= 0000 NOT SIGNIFICANT.
In 3 groups, 4(40%) in group1, 4(40%) in group2 and 2(20%) in group3 observed.
No statistically significant differences in distribution of patients assigned to the 3 groups
Pie Chart
49
50
Case Processing Summary
Cases
Valid Missing Total
N Percent N Percent N Percent
AGE GROUP * Thromboembolism
200 100.0% 0 0.0% 200 100.0%
SE CLASS * Thromboembolism
200 100.0% 0 0.0% 200 100.0%
BMI GROUP * Thromboembolism
200 100.0% 0 0.0% 200 100.0%
GRAVIDA * Thromboembolism
200 100.0% 0 0.0% 200 100.0%
PARA * Thromboembolism 200 100.0% 0 0.0% 200 100.0%
LIVE * Thromboembolism 200 100.0% 0 0.0% 200 100.0%
ABORTIO * Thromboembolism
200 100.0% 0 0.0% 200 100.0%
P/H THROMBOEMBOLISM
* Thromboembolism
200 100.0% 0 0.0% 200 100.0%
H/SURGERY * Thromboembolism
200 100.0% 0 0.0% 200 100.0%
IMMOVABILITY * Thromboembolism
200 100.0% 0 0.0% 200 100.0%
VERICOSE VEIN * Thromboembolism
200 100.0% 0 0.0% 200 100.0%
GHT * Thromboembolism 200 100.0% 0 0.0% 200 100.0%
51 ANEMIA *
Thromboembolism
200 100.0% 0 0.0% 200 100.0%
NICU * Thromboembolism 200 100.0% 0 0.0% 200 100.0%
RD * Thromboembolism 200 100.0% 0 0.0% 200 100.0%
PHOTO * Thromboembolism 200 100.0% 0 0.0% 200 100.0%
FET INFEC * Thromboembolism
200 100.0% 0 0.0% 200 100.0%
DEATH * Thromboembolism 200 100.0% 0 0.0% 200 100.0%