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Cesarean Delivery
This comprehensive
analysis systematically reviewed 60 authoritative studies related to postpartum
VTE outcomes. Investigators found that CS carries a fourfold greater VTE risk
than VD. "We found that CS is an important independent risk factor for the
development of VTE in the postpartum period and that approximately three VTE
will occur for everything 1,000 CS performed, with greater risks for
nonscheduled emergency CS," said lead investigator Marc Blondon, MD,
Division of Angiology and Hemostasis, Geneva University Hospitals, Geneva
Switzerland. These risks were largely independent of other factors like maternal
age and body mass index.
Pregnant women become
more susceptible to VTE due to a variety of factors, including venous stasis
and trauma associated to delivery. Also, hemostatic changes drive increases in
some coagulation factors, while decreasing bleeding inhibitors, but for some
reason these changes seem to be worse for women who deliver via CS. "In
the postpartum period specifically, women following CS exhibit greater
activation of coagulation than women following VD, as reflected by greater
D-dimer levels," explained Dr. Blondon. D-dimer levels indicate that blood
clots may be forming or breaking down in the body. "This outcome may be a
result of the conditions leading to the CS or to the procedure itself, similar
to the increased VTE risk following non-obstetric surgery. Furthermore,
physical activity is reduced following CS compared with following VD, with
delayed recovery of mobility occurring in the first two days following
delivery."
As with many
non-obstetric surgical procedures, thromboprophylaxis, or preventive measures
taken to try and stop VTE before it happens, is commonly employed to try and
minimize risk; however, researchers found little evidence on the use of
thromboprophylaxis after CS.
Key words: Cesarean
Delivery, pregnancy.
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