# Risk factors of pulmonary embolism in postpartum women

## TL;DR

This study identifies risk factors for pulmonary embolism in postpartum women, including prior venous thromboembolism and high d-dimer levels.

## Contribution

The study identifies specific clinical and laboratory risk factors for postpartum pulmonary embolism and proposes a d-dimer cutoff for monitoring.

## Key findings

- Venous thromboembolism and abnormal echocardiography are independent risk factors for postpartum pulmonary embolism.
- A d-dimer level above 2.24 mg/L is a specific marker for monitoring pulmonary embolism in postpartum women.
- Clinical and laboratory differences were observed between postpartum women with and without pulmonary embolism.

## Abstract

Pulmonary embolism (PE) is a potentially fatal complication, especially in postpartum women.

To explore the risk factors of PE in postpartum women.

A retrospective cohort study consisted of 130 postpartum women with PE (PE Group) and 192 postpartum women without PE (non-PE Group), which were analyzed.

The PE group was older, with 37.7% having multiple deliveries, and the inter-pregnancy interval was mostly 1–3 years (p < 0.05). The incidence of prophylactic anticoagulation, anemia, prenatal fever, emergency cesarean section, twins, postpartum acute infection, intraoperative bleeding, postpartum hemorrhage, and venous thromboembolism (VTE) was significantly higher in the PE group. Abnormal clinical manifestations and echocardiographic measures were more common (p < 0.05). The levels of creatinine, urea nitrogen, fibrinogen, total protein, and albumin in the PE group were significantly lower, whereas total bilirubin, d-dimer, and B-type Natriuretic Peptide (BNP) were significantly higher (p < 0.05). The ROC curve analysis showed the best cutoff point for d-dimer level within postpartum women was 2.24 mg/L (specificity 90.1%, sensitivity 88.9%). On multivariate analysis, VTE and abnormal echocardiography were independent risk factors for PE (p < 0.05). The d-dimer levels (OR 1.363, 95% CI 1.716–8.907, p = 0.001) were a specific marker for clinical monitoring of PE.

It was necessary to strengthen the clinical monitoring of PE-related risk factors in postpartum women, especially in those with VTE, abnormal echocardiography, and a d-dimer level > 2.24 mg/L.