Perioperative risk factors for postpartum pulmonary embolism in Taiwanese Cesarean section women

Objective: To explore the perioperative risk factors for predicting postpartum pulmonary embolism (PE) in Taiwanese women with Cesarean section (CS) delivery. Methods: Data from Taiwan Longitudinal Health Insurance Database were analyzed. All CS women (2002 e2007) in Taiwan, according to Diagnosis-Related Group codes, were included. Women having postpartum PE were identified by the diagnosis codes of PE from the medical records within 40 days after CS. Risk factors were analyzed using multivariate logistic regression. Results: A total of 285,043 women who received CS between 2002 and 2007 were analyzed. Among them, 44 women were diagnosed as having postpartum PE. The overall incidence of postpartum PE was 0.154 per 1000 CS women. Analysis revealed that the perioperative risk factors for predicting postpartum PE in CS women included chronic heart disease (adjusted odds ratio [OR] = 89.92, 95% confidence intervals [CI] = 41.34e195.60, P < 0.001), systemic lupus erythematosus (adjusted OR = 45.05, 95% CI = 7.56e268.40, P < 0.001), postpartum hemorrhage (adjusted OR = 3.20, 95% CI = 1.10e9.31, P = 0.033), postpartum blood transfusion (adjusted OR = 8.92, 95% CI = 4.17e19.09, P < 0.001) and postpartum infection (adjusted OR = 7.13, 95% CI = 2.93e17.38, P < 0.001). Of note, anesthetic mode was not a risk factor for predicting postpartum PE in CS women, as women receiving general anesthesia for CS delivery were not associated with an increased risk of developing postpartum PE comparing to those who received neuraxial anesthesia (adjusted OR = 1.28, 95% CI = 0.52e3.14, P = 0.591). Conclusions: Chronic heart disease, systemic lupus erythematosus, postpartum hemorrhage, postpartum blood transfusion and postpartum infection, but not anesthetic mode, were strong perioperative risk factors for predicting postpartum PE in Taiwanese CS women.