Pregnancy-Induced Hypertension, But Not Gestational Diabetes Mellitus, Is a Risk Factor for Venous Thromboembolism in Pregnancy

BACKGROUND AND OBJECTIVES: The aim of this study was to identify the association of pregnancy-induced hypertension (PIH) or gestational diabetes mellitus (GDM) with the development of venous thromboembolism (VTE). SUBJECTS AND METHODS: This was a retrospective study of 57,009 pregnancies during 2002-2008 at Cheil General Hospital, Kwandong University. The diagnosis of VTE {deep vein thrombosis or pulmonary embolism (PE)} was based on clot visualization via ultrasound or computed tomography. RESULTS: In total, 27 cases (PE, 20 cases) were detected. The incidence of VTE was 0.47 per 1,000 pregnancies. To determine risk factors associated with pregnancy-induced VTE, univariate analysis using a chi-square test was performed. Cesarean (C)-section, multiple pregnancy, PIH, placenta previa, and assisted reproduction technique (ART) were statistically significant compared to the controls (all, p=0.000). However, age, premature rupture of membrane, and GDM were not statistically related to VTE. Logistic regression analysis was used to calculate the odds ratios for the risk factors. Placenta previa showed a 12.6-fold higher risk, while PIH had a 9.8-fold higher risk for the occurrence of VTE. C-section and ART procedures increased the risk of VTE by 4.2 times compared to that of the controls. CONCLUSION: Placenta previa and PIH were significant risk factors for VTE, whereas the known traditional risk factors of increased age and GDM were not found to be associated with VTE.

Role of B-type natriuretic peptide in the recurrence of atrial fibrillation after electrical cardioversion / 대한내과학회지

BACKGROUND/AIMS: No studies have conclusively determined whether the B-type natriuretic peptide (BNP) level measured before electrical cardioversion for atrial fibrillation (AF) is associated with the maintenance of sinus rhythm after the procedure. Therefore, we investigated whether the plasma BNP can predict AF recurrence in the short-term. METHODS: We prospectively recruited 20 consecutive patients with persistent AF, without symptomatic congestive heart failure. The plasma BNP was measured before and after electrical cardioversion. RESULTS: In all patients, AF was converted to normal sinus rhythm (NSR) after the procedure. NSR was maintained in 70.0% of the patients at 1 week and in 52.6% of the patients at 4 weeks. Of the patients with NSR at 1 week, five patients had relapsed by 4 weeks (4-week relapse group, 4WRG). The log BNP levels after cardioversion decreased significantly in all patients, except for the failed group at 1 week and the 4WRG. Multivariate analysis revealed that the maintenance of sinus rhythm was associated with body mass index at 1 week, and left atrial diameter (LAD) and left ventricular mass index (LVMI) at 4 weeks. 4WRG had a significantly higher baseline BNP. The baseline BNP was associated with the LVMI (R2=0.241, p=0.028) and tissue Doppler imaging (TDI) E' (R2=0.432, p=0.002). CONCLUSION: A higher plasma BNP at baseline in AF patients may help to predict the failure to maintain sinus rhythm 4 weeks after electrical cardioversion, but not the early recurrence at 1 week.

Thromboembolism during pregnancy or postpartum / 대한내과학회지

BACKGROUND/AIMS: Venous thromboembolism (VTE) during pregnancy or postpartum is a major cause of maternal complications and death; however, the risk is uncertain. In this study, we sought to estimate the incidence of VTE during pregnancy and to identify risk factors for pregnancy-related VTE. METHODS: We retrospectively evaluated the incidence, risk factors, treatment, and prognosis for VTE based on 40,989 deliveries at Cheil General Hospital, Kwandong University College of Medicine, over a five-year period from February 2003 to January 2008. The risk factors were analyzed by chi-square-analysis and forward stepwise logistic regression, and are presented as crude and adjusted odds ratios (ORs) with a 95% confidence interval (CI). RESULTS: The incidence of VTE was 0.042% (17 patients, mean age 32.4+/-2.5 years), with deep venous thrombosis (DVT) in 0.01% of the patients (4 patients, mean age 31.5+/-2.9 years), and pulmonary embolism (PE) in 0.032% of the patients (13 patients, mean age 32.6+/-2.5 years). The postnatal incidence of VTE was higher than the antenatal incidence (2 vs. 15). The main manifestations at the time of diagnosis, in order of frequency, were: dyspnea in 8 patients (62%), chest pain in 4 patients (31%), cough in 2 patients (15%), and syncope in 1 patient (8%). The risk factors for VTE were Cesarean section (OR=7.4; 95% CI: 2.1-25.7, p=0.002) and preeclampsia (OR=12.0; 95% CI: 4.2-34.2, p<0.000). All cases showed clinical improvement spontaneously, or with anticoagulation and surgical thrombectomy, and caused no fetal or maternal mortality. CONCLUSIONS: The incidence of VTE during pregnancy was 0.042%; the independent risk factors were Cesarean section and preeclampsia.