Incidence and Clinical Profile of Venous Thromboembolism in Pregnancy and Puerperium at Kenyatta National Hospital Between January 2013 and December 2017.

Abstract

BACKGROUND: Venous thromboembolism (VTE) is associated with severe morbidity and is currently among the leading causes of maternal mortality in the high income countries. Pregnancy increases the risk of venous thromboembolism in women by 4 to 5 times compared to that of age-matched non-pregnant women. Presentation of VTE in pregnancy is nonspecific as most of the signs and symptoms tend to overlap with some of the normal physiological changes associated with pregnancy which further poses a challenge in diagnosis. Management of VTE in pregnancy is also challenging due to the fetal safety concerns of the medications used. The burden and management of obstetric VTE in Kenya has not been recently evaluated despite the ongoing changes in the diagnosis and management STUDY OBJECTIVE: To evaluate the incidence and clinical profile of venous thromboembolism during pregnancy and puerperium in Kenyatta National Hospital between January 2013 and December 2017. STUDY DESIGN: The study was a 5-year retrospective descriptive cohort study from January 2013 to December 2017 conducted at Kenyatta National Hospital. RESULTS: The 5-year incidence of obstetric VTE in KNH was 1.8 per 1,000 deliveries. DVT accounted for 94.9% of all obstetric VTEs while pulmonary embolism accounted for 5.1% of the cases. 74.5% of obstetric VTEs occurred in the antenatal period while 25.5% occurred in the post-natal period. In the antenatal period the third trimester had the highest number of cases 39.2%, second trimester had 32.4% and first trimester 28.4% of the cases. The left lower limb was the commonly affected limb with pain and swelling being the most common presenting symptoms occurring in 96.4% and 95.6% of the cases respectively. For patients with pulmonary embolism chest pain and dyspnea were the commonest presenting symptoms reported in 100% and 71.4% of patients respectively. All patients were managed medically and there was 1(1.7%) maternal death.

CONCLUSION AND RECOMMENDATION: The incidence of obstetric VTE in KNH is similar to that reported in similar studies. There should be a high index of suspicion of VTE in obstetric patients presenting with lower limb swelling, pain, chest pain and dyspnea.