827: Antepartum and postpartum risk factors for VTE in pregnancy at the toledo hospital

Abstract

STUDY DESIGN: A five-year retrospective review was undertaken of all computed tomographic pulmonary angiograms (CTPAs) performed on obstetric patients at Galway University Hospital, a tertiary level centre, delivering approximately three thousand babies a year, between 2011 and 2016. Formal reports of each CTPA were reviewed via the hospital's electronic database IMPAX. Data including age, presenting symptoms and signs, pre/post-natal status, and results were collected. The proportion of suboptimal images was noted as was the incidence of other relevant pathology detected by scan. Data was analysed and the positive and negative yields calculated. Statistical analysis was performed to determine whether the difference in numbers between antenatal and postnatal groups was significant. RESULTS: A total of 149 CTPA scans were performed. Eighty-four (56.4%) of these were on antenatal patients and sixty-five (43.6%) on postpartum patients. Only five (5.9%) of the CTPAs performed antenatally were positive whereas nine patients (13.8%) were positive in the postnatal group (p¼0.101) Total positive yield was 9.4% (14/ 149). For each positive result there were nine negative CTPAs performed. A total of 32 scans (21.47%) were reported as demonstrating suboptimal images. Subsegmental emboli could not be fully excluded in this group and further imaging was required in cases on on-going clinical suspicion. Twenty-four (16%) scans reported other relevant pathological findings. These commonly showed evidence of consolidation, effusions and atelectasis but other unusual findings were also picked up including liver lesions, lymphadenopathy, cavitary masses and a retrosternal thyroid nodule. Many unexpected findings required further follow-up imaging. CONCLUSION: CTPA exposes maternal breast tissue to a radiation dose that can increase women's lifetime risk of breast cancer. This study highlights the dilemma of clinical management in pregnant and postnatal women with chest symptoms. It also demonstrates the usefulness and limitations of using CTPA as an imaging modality it this cohort. OBJECTIVE:A growing body of evidence suggests that antepartum and postpartum VTE have distinct pathophysiological etiologies. The aim of this study was to identify and compare the risk factors for both time periods. STUDY DESIGN: A case-control study was performed; cases were defined as antepartum or postpartum VTE at Toledo Hospital (2010)(2011)(2012)(2013)(2014)(2015). VTE-free controls were frequency matched 1:3 by age and race. Data was extracted from paper-based records and EHR. A VTE was confirmed by objective imaging (duplex Doppler, CTA or V/Q scan). Patients with prior history of VTE or known coagulopathies were included in the study. Analysis was performed with SPSSv19. RESULTS:A total of 83 cases (antepartum n¼51, postpartum n¼32) and 243 controls were identified. From more than 40 candidate variables only few were significantly associated with VTE. Antepartum risk factors for VTE included: 1) personal history of VTE (OR 10.3, 95% CI 2.5-41.7...