| Objective:To observe the dynamic changes of plasma D-dimer before and after delivery and the effects of different intervention measures on plasma D-dimer in puerperal women,and further explore the significance of prevention of thrombo-related diseases in puerperal women,so as to provide necessary clinical evidence for prevention and screening Methods: Using the method of case-control study,according to the evaluation criteria of the guidelines for the diagnosis and treatment of venous thromboembolism in pregnancy and puerperium issued by the Royal College of Obstetricians And Gynaecologists(RCOG)in April 2015,the postpartum score is ≥2 points As the criteria for having high risk factors for thrombosis,120 puerperae who were registered in our hospital for regular obstetric inspection from September2020 to September 2021 were selected for natural delivery or post-cesarean section.80 puerperae with score is ≥2 points were selected as the study group(group A),and 40 puerperae with a score of less than 2 points during normal delivery or cesarean section during the same period were set as the control group(group B),40 cases in the research group were divided into A1 group,postpartum prophylactic use of low molecular-weight heparin(LMWH)to prevent thrombosis,and 40 cases were divided into A2 group,postpartum did not use low molecular weight heparin,took general treatment and physical therapy The treatment method was to prevent thrombosis.40 cases of puerperae in group B were given general treatment after delivery,and the changes of plasma D-dimer were observed.According to the principle of informed consent,5 ml of venous blood was drawn from the puerperae one week before delivery,Plasma D-dimer level was determined by latex immunoturbidimetry,and clinical adverse events of GROUP A1 treated with LMWH were analyzed.Results: 1.There was no statistical significance in the prenatal D-dimer level among the three groups.2.After evaluation by RCOG thrombosis risk scoring criteria,the postpartum D-dimer level of all enrolled women was higher than the prenatal D-dimer level in horizontal comparison(P<0.05),while the longitudinal comparison showed no significant difference between 6-12 hours postpartum D-dimer level(P>0.05),but the higher the score,the higher the D-dimer level.3.On the third day after intervention,the d-dimer level of group A1(1.15±1.12 mg/l)was significantly lower than that before intervention(2.62±0.41 mg/l)(P<0.05).Longitudinal comparison on the third day after intervention,d-dimer level in A1 group was lower than that in A2 group,the difference was statistically significant(P<0.05).4.One case of petechiae at injection site occurred during LMWH administration,The incidence of adverse events was2.5%.Conclusions: 1.The increased d-dimer level after delivery combined with the RCOG thrombosis risk score showed that the risk of thrombosis increased during puerperium compared with pregnancy.2.After taking different preventive measures,the d-dimer level could decrease to different degrees,among which the decrease of D-dimer was more obvious due to preventive drugs,and the decrease of D-dimer level was more significant by LMWH prevention than physical prevention and basic prevention methods in the prevention of VTE.3.Puerperium has high risk factors for thrombosis It is necessary to take measures to keep the D-dimer low status,LMWH is suitable for the high risk population,physical prevention and basic prevention is suitable for the low risk,Such as plasma D-dimer reaching normal diagnosis could be eliminated,but conversely plasma D-dimer is normal,healthy maternal unusually high during this period,the rising trend,... |
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