Organizational Factors of Pregnancy-Related Venous Thromboembolism Compared in Hospitals in China

Qiongjie Zhou, MD, PhD, and colleagues from the Department of Obstetrics of the Obstetrics and Gynecology Hospital of Fudan University in Shanghai, China, recently published a study in which they aimed to identify “organizational factors affecting venous thromboembolism (VTE) incidence and variations between hospitals” in China. Based on their observations, they concluded that organizational factors, such as hospital resource availability and competency, played an important role in varying prevalence of thromboembolism during pregnancy in Chinese hospitals.

The study, published in Clinical and Applied Thrombosis/Hemostasis, included a survey (2019) of VTE and live births in 113 hospitals. The investigators reviewed the following: Organizational factors, such as hospital type, characteristics, and live birth number; resource availability, including D-dimer, B-scan ultrasonography of lower extremity veins, and computed tomographic pulmonary angiography (CTPA); and  competency, based on risk assessment, use of anticoagulants, and patient education.

According to Dr. Zhou, among the 113 hospitals, there were 770,828 live births and 526 reported cases of VTE, for a rate of 68.2 per 100,000 live births. The authors noted that “nine hospitals lacked B-scan ultrasonography of lower extremity veins and 22 lacked CTPA.” Additionally, the prevalence rates of VTE were higher for general hospitals (odds ratio [OR] = 4.251; 95% confidence interval [CI], 3.373–5.357), hospitals with under 10,000 live births (OR = 1.650–2.193), and hospitals without B-scan ultrasonography (OR = 1.661; 95% CI, 1.096–2.518). Finally, in hospitals with patient education processes, the investigators observed a lower risk of VTE (OR = 0.296–0.374).

The authors concluded that “additional efforts should be accelerated towards the improvement of hospital resources and competency towards reducing the risk of VTE related maternal mortality and morbidity.”

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