A survey on the current clinical practices among obstetricians for the management of venous thromboembolism prevention in various hospitals in China.

BACKGROUND: Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is one of the major causes of mortality in pregnant women. Clinical practices followed by obstetricians in different hospitals might influence the incidence and prevalence rates of VTE. This obstetrician-based survey was conducted to understand the establishment of VTE prevention and treatment system and its current scenario in various hospitals for preventing VTE during pregnancy. OBJECTIVES: An obstetrician-based survey was conducted to understand the establishment of VTE prevention and treatment system during pregnancy and its current scenario in various hospitals across China. METHODS: A questionnaire-based survey was conducted among 1128 obstetricians from July 1 to 312,024 in 22 provinces, 5 autonomous regions and 4 municipalities across China. Responses on hospital infrastructure (grade, type, resource allocation) with respect to VTE management, VTE prevention and treatment system establishment, and health education was collected. The data was analyzed by using R software and P value of <0.05 was considered significant. RESULTS: Ultrasonography of the lower extremity veins was not performed in 11.89% of the hospitals, while the unavailability of computed tomographic pulmonary angiography (CTPA) and pulmonary ventilation/perfusion (V/Q) scintigraphy was reported in over 50% and 80% of the hospitals, respectively. Tertiary hospitals outperformed primary and secondary hospitals in all VTE prevention system indicators (P < 0.001), and general hospitals surpassed specialized hospitals in multiple aspects (P < 0.05). Only 67.1% of physicians performed VTE risk assessment on all pregnant women, with significant disparities by hospital level (P < 0.001). VTE patient education was not universal and varied significantly by hospital level (P < 0.001), being most comprehensive in tertiary hospitals. CONCLUSION: VTE prevention and treatment infrastructure in some Chinese hospitals are insufficient. The survey identified gaps between the clinical practice of obstetricians and national/international guidelines or consensus requirements. Following uniform clinical practices across the different hospital settings would help to improve VTE prevention in pregnant women in China.