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.