TOPLINE: 

Nearly half of maternal deaths from venous thromboembolism (VTE) in France over 12 years were preventable, with most women having cumulative moderate risk factors rather than single major ones. More than one third of women who died from postpartum VTE had acquired risk factors from obstetric complications such as postpartum hemorrhage or preeclampsia.

METHODOLOGY:

• Researchers conducted a retrospective descriptive study of all maternal deaths resulting from VTE in France from 2007 to 2018, identified through the nationwide enhanced maternal mortality surveillance system (Enquête Nationale Confidentielle sur les Morts Maternelles).
• A total of 80 maternal deaths with complete clinical documentation were analyzed, comprising 37 (46.2%) antepartum VTE cases and 43 (53.8%) postpartum VTE cases.
• Maternal characteristics, clinical features, VTE risk factors, thromboprophylaxis received, and concordance with French national guidelines were described for antepartum and postpartum groups.
• Preventability of each death was assessed by the National Expert Committee on Maternal Mortality, categorized as probably preventable, possibly preventable, not preventable, or insufficient information to conclude.
• Analysis compared women’s characteristics with published aggregate data from the 2010 and 2016 National Perinatal Surveys, which are contemporary national representative samples of all women who gave birth at ≥ 22 weeks of gestation in France.

TAKEAWAY:

• During the 12-year study period, 99 women died from VTE with a maternal mortality ratio of 1.03 per 100,000 live births (95% CI, 0.84-1.25), which remained stable over time.
• VTE risk factors were present in 67.6% (25/37) of antepartum cases and 93.0% (40/43) of postpartum cases, with women more often having obesity, age ≥ 35 years, parity ≥ 3, preeclampsia, and postpartum hemorrhage than the general population.
• Among women with only minor risk factors, two thirds (35/50, 70.0%) had a combination of several risk factors; the median number of minor risk factors was 1 (interquartile range [IQR], 0-1) for antepartum deaths and 3 (IQR, 1.00-4.00) for postpartum deaths.
• Thromboprophylaxis was indicated for 37.5% (30/80) of women, according to French guidelines, but 43.3% (13/30) did not receive it and 26.7% (8/30) received an inappropriate dose or duration.

IN PRACTICE:

“Nearly half of VTE-related maternal deaths were preventable. Women who died had a high prevalence of cumulative moderate VTE risk factors as well as acquired factors related to obstetric complications. This underlines the importance of repeated assessment along pregnancy to integrate the evolutionary nature of VTE risk in the obstetric population and improve the quality of care,” the authors of the study wrote.

SOURCE:

The study was led by Agnes Rigouzzo, MD, Department of Anesthesiology and Critical Care, Armand Trousseau University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France. It was published online in Obstetrics & Gynecology.

LIMITATIONS:

All VTE-related maternal deaths could not be included due to missing clinical information for 20% of them, and some risk factors may have been underestimated if not reported in medical files. Information on a drug regimen was sometimes missing, making it difficult to analyze reasons for thromboprophylaxis failures in some cases. The researchers cannot exclude the possibility that in some women, the proposed thromboprophylaxis was declined or not taken by the patient. The 20 women excluded from analysis more often died out of hospital, which probably contributed to the lack of clinical information available for review. 

DISCLOSURES:

The French national confidential enquiry into maternal deaths received funding from the National Public Health Agency (Santé Publique France) and the National Institute of Health and Medical Research. No relevant conflicts of interest were disclosed by the authors.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.