Perfil de risco para o desenvolvimento de tromboembolismo venoso em gestantes e puérperas internadas na maternidade de um hospital escola do interior do Rio Grande do Sul.

Abstract

Introduction: During pregnancy, numerous physiological changes occur in the maternal organism, involving anatomical, metabolic, and immunological changes, aiming at adaptation to the developing concept. Consequently, during the approximately 40 weeks of gestation, there is a greater risk of developing venous thromboembolism, which today is the leading cause of morbidity and mortality in pregnant and postpartum women. General Objective: To analyze the risk profile for developing venous thromboembolism (VTE) using the Royal College of Obstetricians and Gynecologists SCORE in pregnant and postpartum women hospitalized in the maternity ward of a teaching hospital in a small town in Rio Grande do Sul. Article I: Risk of venous thromboembolism in pregnant and postpartum women admitted to the maternity ward of a hospital in the interior of the state of Rio Grande do Sul, Brazil. Objective: To identify whether there is an increased risk for the development of VTE in pregnant and postpartum women admitted to the maternity ward of a referral hospital for high risk pregnancy in the interior of the state of Rio Grande do Sul, Brazil. Method: Application of the SCORE for VTE developed by the Royal College of Obstetricians and Gynecologists (RCOG) in pregnant and postpartum women admitted to the hospital's maternity ward. As specific SCORE criteria, a score ≥ 2 in postpartum women and ≥ 3 in pregnant women was used. Results: A total of 180 patients were interviewed, 134 of which were postpartum women and 46 were pregnant women. Through these criteria, the presence of numerous risk factors for VTE was verified, such as obesity, parity ≥ 3, hyperemesis, preeclampsia, among others; in addition, it was observed that 79.1% of postpartum women and 54.4% of pregnant women had scores ≥2 and ≥ 3, respectively. Conclusion: The study showed an increased risk for the development of VTE for both pregnant and postpartum women admitted to the maternity ward. The participants who formed the sample need antithrombotic prophylaxis, either in the gestational period or in the puerperium. In addition, several preventive measures can be adopted through non-pharmacological methods, such as early ambulation and use of a compression garment, or pharmacological methods, such as low-molecular-weight heparins, in order to reduce the risk of VTE. Article II: Influence of the period of pandemic (COVID-19) on the risk profile for venous thromboembolism in postpartum women. Introduction: Venous Thromboembolism (VTE) is the primary pathology related to the death of pregnant and postpartum women. In this context, the literature has described that the COVID-19 pandemic may increase the risk for the development of VTE. Objective: To compare the databases of patients admitted to the maternity hospital in the years 2019 and 2021 about risk factors for VTE. Method: Comparative analysis of data from medical records and bedside interviews of patients admitted to the maternity ward of a teaching hospital in the interior of Rio Grande do Sul - RS, in the pre-pandemic and pandemic period of COVID-19. Results: It was observed that several risk factors for VTE remained stable or with slight variations, but without significant difference, but others, such as the number of emergency cesarean sections, presence of preeclampsia, obesity, varicose veins, hyperemesis, and dehydration, showed a significant increase. Conclusion: Throughout the pandemic, hospitalized patients had an increased risk of VTE. In this context, greater attention is recommended to puerperal women with obesity, preeclampsia, a history of thromboembolism, or thromboembolic disease, especially those affected by COVID-19, seeking prudent management due to a greater risk of severe disease due to SARS-COV-2 or development of TEV. Final considerations of the dissertation: With the advances in medicine, the development of new techniques, and non-invasive and safer imaging tests for the mother-fetus binomial, the detection of patients with thromboembolism is faster and safer. Thus, given the suspicion of the pathology and its morbidity and mortality, care is urgent in evaluating and instituting adequate antithrombotic prophylaxis, whether pharmacological or not, to minimize the occurrence of injury and eventual sequelae. Following existing guidelines internationally, screening with an estimate of the risk of VTE in patients from the beginning of prenatal care is established as a fundamental measure whenever there is any significant change during this period.