PREVALENCE OF THROMBOEMBOLISM IN PREGNANCY AND PUERPERIUM IN A TERTIARY CARE CENTER AND RISK FACTOR ASSESSMENT – A CROSS SECTIONAL STUDY

(1)

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)

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., DNB

Prof & 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)

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)

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)

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)

6

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)

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)

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

^rd

of 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)

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)

10

(11)

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)

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)

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)

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)

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)

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)

17

(18)

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)

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

% of Total 69.0% 5.5% 74.5%

Total Count 181 19 200

% of Total 90.5% 9.5% 100.0%

Chi-Square Tests

Value df

Asymptotic Significance (2-

sided)

Exact Sig. (2- sided)

Pearson Chi-Square 3.047^a 1 .081

Continuity Correction^b 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)

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

% of Total 20.0% 0.0% 20.0%

2 Count 117 19 136

(21)

21

% of Total 58.5% 9.5% 68.0%

3 Count 24 0 24

% of Total 12.0% 0.0% 12.0%

% of Total 90.5% 9.5% 100.0%

Value df

sided)

Linear-by-Linear Association .426 1 .514

CHI SQUARED= 9.880 P= 0.007 SIGNIFICANT.

(22)

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

^nd

group with other groups

**GRAVIDA * Thromboembolism**

Crosstab

Thromboembolism

Total

NO YES

GRAVIDA 1 Count 125 11 136

% of Total 62.5% 5.5% 68.0%

2 Count 48 0 48

% of Total 24.0% 0.0% 24.0%

3 Count 8 8 16

% of Total 4.0% 4.0% 8.0%

% of Total 90.5% 9.5% 100.0%

Value df

sided)

(23)

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

% of Total 66.5% 5.5% 72.0%

1 Count 40 0 40

% of Total 20.0% 0.0% 20.0%

2 Count 8 8 16

(24)

24

% of Total 4.0% 4.0% 8.0%

% of Total 90.5% 9.5% 100.0%

Value df

sided)

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)

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

% of Total 70.5% 5.5% 76.0%

1 Count 32 0 32

% of Total 16.0% 0.0% 16.0%

2 Count 8 8 16

% of Total 4.0% 4.0% 8.0%

% of Total 90.5% 9.5% 100.0%

Value df

sided)

(26)

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

% of Total 86.5% 9.5% 96.0%

1 Count 8 0 8

% of Total 4.0% 0.0% 4.0%

% of Total 90.5% 9.5% 100.0%

(27)

27

Value df

sided)

Pearson Chi-Square .875^a 1 .350

Continuity Correction^b .102 1 .749

Fisher's Exact Test 1.000 .443

a. 1 cells (25.0%) have expected count less than 5. The minimum expected count is .76.

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)

28

**H/SURGERY * Thromboembolism**

Crosstab

Thromboembolism

Total

NO YES

H/SURGERY 0 Count 178 9 187

% of Total 89.0% 4.5% 93.5%

1 Count 3 10 13

% of Total 1.5% 5.0% 6.5%

% of Total 90.5% 9.5% 100.0%

Value df

sided)

(29)

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

% of Total 89.0% 5.5% 94.5%

1 Count 3 8 11

% of Total 1.5% 4.0% 5.5%

% of Total 90.5% 9.5% 100.0%

(30)

30

Value df

sided)

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)

31

**VARICOSE VEIN * Thromboembolism**

Crosstab

Thromboembolism

Total

NO YES

VERICOSE VEIN 0 Count 181 11 192

% of Total 90.5% 5.5% 96.0%

1 Count 0 8 8

% of Total 0.0% 4.0% 4.0%

% of Total 90.5% 9.5% 100.0%

Value df

sided)

(32)

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

% of Total 82.5% 5.5% 88.0%

1 Count 16 8 24

% of Total 8.0% 4.0% 12.0%

(33)

33

% of Total 90.5% 9.5% 100.0%

Value df

sided)

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)

34

**ANEMIA * Thromboembolism**

Crosstab

Thromboembolism

Total

NO YES

ANEMIA 0 Count 152 0 152

% of Total 76.0% 0.0% 76.0%

1 mild

Count 21 19 40

% of Total 10.5% 9.5% 20.0%

2 Count 2 6 8

severe

% of Total 1.0% 3.0% 4.0%

% of Total 90.5% 9.5% 100.0%

Value df

sided)

(35)

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

% of Total 34.5% 5.5% 40.0%

1 Count 112 8 120

% of Total 56.0% 4.0% 60.0%

% of Total 90.5% 9.5% 100.0%

(36)

36

Value df

sided)

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)

37

**RD * Thromboembolism**

Crosstab

Thromboembolism

Total

NO YES

RD 0 Count 69 11 80

% of Total 34.5% 5.5% 40.0%

1 Count 112 8 120

% of Total 56.0% 4.0% 60.0%

% of Total 90.5% 9.5% 100.0%

Value df

sided)

(38)

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

% of Total 86.5% 9.5% 96.0%

1 Count 8 0 8

% of Total 4.0% 0.0% 4.0%

% of Total 90.5% 9.5% 100.0%

(39)

39

Value df

sided)

Fisher's Exact Test 1.000 .443

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)

40

**DEATH * Thromboembolism**

Crosstab

Thromboembolism

Total

NO YES

DEATH 0 Count 165 19 184

% of Total 82.5% 9.5% 92.0%

1 Count 16 0 16

% of Total 8.0% 0.0% 8.0%

% of Total 90.5% 9.5% 100.0%

Value df

sided)

(41)

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)

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

Value df

sided)

Likelihood Ratio .477 1 .490

(43)

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

% of Total 82.5% 5.5% 88.0%

1 Count 16 8 24

% of Total 8.0% 4.0% 12.0%

% of Total 90.5% 9.5% 100.0%

Value df

sided)

(44)

44

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

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)

45

YES Count 2 1 3

Value df

sided)

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)

46 HEPARIN

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

1 Count 28 4 32

Value df

sided)

(47)

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

MILD Count 15 4 19

SEVERE Count 3 2 5

Value df

sided)

(48)

48

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)

49

(50)

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)

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%

PREVALENCE OF THROMBOEMBOLISM IN PREGNANCY AND PUERPERIUM IN A TERTIARY CARE CENTER AND RISK FACTOR ASSESSMENT – A CROSS SECTIONAL STUDY