4.3 Interpretation
In this hospital-based VTE survey, the incidence of VTE has covered in a
nation-wide range. Based on the existing literature, the VTE prevalence
was focused on targeted high-risk populations or on the regional rate.
Moreover, due to the increasing application rate of diagnostic methods,
the incidence was expected to be elevated. Therefore, it is necessary to
investigate the status of VTE in China. In this study, we found that the
average prevalence of DVT and PE was 54.9 and 13.4 per 100,000 live
births, respectively, consistent with previous reports in the United
States and European countries.
More importantly, the enhancement of hospital resource availability and
patient education quality is beneficial in reducing the risk of VTE. We
found that the presence of established preventive strategies, including
the hospital management system and risk assessment, as well as emergency
transfer were associated with a lower incidence of DVT and PE.
Sufficient patient education levels were significantly associated with a
lower risk of VTE in pregnancy, and were widely implemented in more than
80% of the hospitals. There is a need for the provision of detailed
health-related education, especially in terms of early mobilization both
after vaginal delivery and Cesarean section. These organizational and
health promotion factors are adequately modifiable, and should be
highlighted in other healthcare settings.
The presence of sufficient screening and diagnostic methods is expected
to be correlated to a higher reported incidence of DVT and PE. D-dimer
testing and ultrasound of the lower extremity vein were commonly
performed and available in more than 90% of the enrolled hospitals in
China. CTPA was available in 80% of the enrolled hospitals; however,
emergent cases did not have access to the other 20% hospitals. In
addition, the use of elastic stockings, compression devices, and
anticoagulants, which were critical for effective VTE prevention and
treatment, was not observed in all the hospitals. Therefore, a greater
degree of attention should be paid to the promotion of the utilization
of CTPA, elastic stockings, compression devices, and anticoagulants for
the further elimination of the risk of VTE in pregnancy and the related
maternal mortality.
This study has some limitations. First, the hospitals participating in
this survey were mainly tertiary and secondary hospitals, and only one
primary hospital was enrolled. The VTE status in primary hospitals
requires further investigation. Second, this survey was based on a
questionnaire, and the presence of potential reporting bias should be
considered. This survey was completed by the department chief or senior
physicians from the Department of Obstetrics from each hospital, which
ensured the quality of the survey to some extent. In addition, trained
staff members were assigned for data quality control, and they could
telephone the point of contact if there existed any queries.