Epidemiology of pregnancy‐associated pulmonary embolism in South Asian multi‐ethnic country: Mortality trends over the last four decades. Issue 1 (24th August 2020)

• Record Type: Journal Article
• Authors: Tan, Thiam Chye; Goh, Cheryl Ming Ying; Tan, Sophie Seine Xuan; Tan, Lay Kok; Yang, Yong; Lee, Lai Heng
• Is Part Of: Journal of obstetrics and gynaecology research. Volume 47:Issue 1(2021)
• Page Start: 174
• Page End: 183
• Publication Date: 2020-08-24
• Subjects: incidence -- maternal mortality -- pregnancy -- pulmonary embolism -- venous thromboembolism; Gynecology -- Periodicals; Obstetrics -- Periodicals; 618.1005
• DOI: 10.1111/jog.14450
• Languages: English
• ISSNs: 1341-8076

Abstract

Abstract: Objective: To determine the cumulative incidence, time of occurrence and risk factors of pregnancy‐associated pulmonary embolism (PE) in Singapore, and to review the maternal mortality ratio of PE over the last four decades. Study design and setting: In this retrospective epidemiology review, women with pregnancy‐associated PE were identified via International Classification of Diseases codes and included if they had been objectively diagnosed on imaging with PE during pregnancy or within 6 weeks postpartum from 2004 to 2016 at KK Women's and Children's Hospital (KKH) and Singapore General Hospital (SGH) in Singapore. The medical records were reviewed and the time of occurrence of confirmed PE cases and risk factors for PE were noted. Results: There were 18 PE cases out of 174 708 deliveries, of which two were fatal, giving a cumulative incidence of PE at 1.03 per 10 000 deliveries and a mortality rate of 11.1%. The maternal mortality ratio is 1.14 per 100 000 deliveries, the lowest compared to that of the previous three decades (2.5–4.9 per 100 000 deliveries). Majority of PE (66.7%) occurred during the first 2 weeks postpartum. Cumulative incidence of postpartum PE was four times more in caesarean section compared to vaginal delivery at 1.58 per 10 000 deliveries and 0.40 per 10 000 deliveries, respectively. Conclusion: Although the cumulative incidence of pregnancy‐associated PE in Singapore is low, it is comparable to the United Kingdom (UK) and United States (US). Risk assessment and thromboprophylaxis have decreased PE mortality significantly during this period.