Future research directions for prevention and treatment of obstetric venous thromboembolism

Sequential Compression Device Adherence is Low in Hospitalized Antepartum Patients

OBJECTIVE

This study was aimed to describe sequential compression device (SCD) adherence and its associations with SCD education in hospitalized antepartum women.

STUDY DESIGN

This study included antepartum, nonlaboring women admitted from 2016 to 2018, 1 year before and after an SCD education intervention. SCD use was assessed through the Kendall SCD 700 series compliance meter, which tracks the time the SCD machine takes within the monitoring interval. Recruitment occurred after 60 to 80 hours of monitoring, at which time a patient survey was completed. SCD use was the percentage of time the machine was on during monitoring. Mann-Whitney U and Chi-square tests were used to compare associations between SCD use, education, and pharmacologic prophylaxis.

RESULTS

Among 125 recruited women, 123 provided adherence data, 69 before and 54 after the education. Median SCD use was 17.3% before and 20.7% after (p = 0.71). Pharmacologic prophylaxis use was similar between the two periods and was not associated with SCD use. Among 121 surveys, the most common reason as to why SCDs were not worn was prevention of walking (52/121 [43.0%]).

CONCLUSION

Using a novel monitoring technique, we found low-SCD use among antepartum inpatients, which was neither affected by education nor concurrent pharmacologic prophylaxis. Improving mobility with SCDs may improve use in this population.

KEY POINTS

· SCD use was low in this cohort of hospitalized antepartum patients.. · A patient/nursing education intervention was not associated with SCD adherence.. · Concurrent pharmacologic VTE prophylaxis was not associated with SCD adherence..

"You only live twice": multidisciplinary management of catastrophic case in placenta Accreta Spectrum-a case report

Background

Placenta percreta is associated with high hemorrhagic risk and can be complicated with fatal thromboembolic events. Involving a multidisciplinary team in the treatment of these patients is mandatory to reduce morbidity and mortality.

Case presentation

This paper reports the case of a 22-year-old patient with placenta percreta who was referred to our tertiary care center for delivery. Few hours after undergoing a successful cesarean hysterectomy, the patient developed a pulmonary embolism and cardiac arrest. A transthoracic echocardiogram done in the intensive care unit (ICU) showed a thrombus in the right ventricle. After cardiac resuscitation, the patient underwent an urgent thoracotomy and a pulmonary artery thrombectomy; many clots were retrieved from the pulmonary artery. After weaning from extracorporeal circulation, an intraoperative transesophageal cardiac ultrasound enabled the medical team to detect a new free-floating thrombus in the right atrium and right ventricle, and consequently to perform an embolectomy and prevent the patient’s death.

Conclusion

This case emphasizes the role of multidisciplinary team in treating high-risk obstetric cases that could be complicated with massive and fatal thromboembolic events. The use of intraoperative transthoracic echocardiography helps in detecting a new thrombus and guides the anesthesiologist in the intra-operative monitoring.