A British study that bills itself as the first to assess the impact of pre-delivery hospital admission on the incidence of VTE in pregnant women should serve as a clarion call to hospitalists, says a hospital physician and OB/GYN specialist.
Rob Olson, MD, FACOG, founding president of the Society of OB/GYN Hospitalists, says the report confirms empirically what most agree anecdotally: pregnant patients are at increased risk for VTE upon admission to the hospital, and those at highest risk should receive prophylaxis.
Published earlier this month in the British Medical Journal, the open-access report [PDF] found that hospital admissions during pregnancy were associated with a 17-fold increase in the risk of VTE. The risk remained sixfold higher for pregnant women 28 days after discharge, the report noted.
"This really quantifies it in a way I haven't seen before," says Dr. Olson, who practices in Bellingham, Wash. He says internal-medicine hospitalists should keep VTE prophylaxis front-of-mind for pregnant inpatients who during their hospital stay will likely experience a significant amount of bed rest. In those cases, he urges hospitalists to consult an obstetrician or an OB/GYN hospitalist, and consider use of compression devices or low-dose heparin.
"The more we understand the magnitude of the risks, the more we can mitigate against it," Dr. Olson adds. "The problem that you’re dealing with is something that doesn’t happen very often. Internists may see a bunch of pregnant patients and not have any problems. We want every pregnant admission to be a safe admission."