Knowledge, Awareness and Risk of Occurrence of Venous Thromboembolism of Perinatal Women

Eun Sook Kim; Hye Young Kim

doi:10.4069/kjwhn.2019.25.2.154

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Kim and Kim: Knowledge, Awareness and Risk of Occurrence of Venous Thromboembolism of Perinatal Women

Original Article

Korean J Women Health Nurs 2019;25(2):154-168.

Published online: 19 June 2019

DOI: https://doi.org/10.4069/kjwhn.2019.25.2.154

Knowledge, Awareness and Risk of Occurrence of Venous Thromboembolism of Perinatal Women

Eun Sook Kim¹, Hye Young Kim²

¹Researcher, Research Institute of Nursing Science, Keimyung University, Daegu, Korea

²Associate Professor, College of Nursing, Keimyung University, Daegu, Korea

Corresponding author: Hye Young Kim College of Nursing, Keimyung University, 1095 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Korea. Tel: +82-53-258-7661 Fax: +82-53-258-7616 E-mail: hye11533@kmu.ac.kr

Received 2 March 2019 Revised 10 May 2019 Accepted 20 May 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

The purpose of this study is to identify knowledge, awareness, and risk of occurrence of venous thromboembolism among pregnant women.

Methods:

Subjects were 106 pregnant women treated as inpatients and outpatients at a women's health hospital in a metropolitan city February 19–March 22, 2018. Instruments consisted of questionnaires that included knowledge, awareness, and risk of occurrence of venous thromboembolism queries. Collected data were analyzed by t-test, one-way analysis of variance, Mann-Whitney U test and Kruskal-Wallis test.

Results:

Mean score of subjects' knowledge of venous thromboembolism was 4.47 (0–15), mean score of subjects' awareness of venous thromboembolism was 66.98 (25–100), and mean score of subjects' risk factor of venous thromboembolism was 0.98 (0–44).

Conclusions:

Pregnant women's level of knowledge and awareness of prevention and risk factors on venous thromboembolism, is significantly low. To raise their awareness of risk symptoms and prevent occurrence of the disease, it is essential for nurses as well as medical staffs to: 1) provide an educational program on venous thromboembolism for patients; 2) assess and monitor pregnant women with a risk factor of venous thromboembolism; and 3) implement proper prophylaxis for patients.

Keywords: Venous thromboembolism, Pregnancy, Knowledge, Awareness, Risk factors

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Table 1.

General Characteristics of the Subjects (N=106

Characters	Categories	n(%)	M±SD
Age (year)	25–29	14 (13.2)	34.39±3.66
	30–34	55 (51.9)
	≥35	37 (34.9)
Religion	Yes	45 (42.5)
	No	61 (57.5)
Level of education	High school	12 (11.3)
	College/university	83 (78.3)
	Graduate school	11 (10.4)
Job	Yes	34 (32.1)
	No	72 (67.9)
Type of pregnancy	Natural pregnancy	101 (95.3)
	Test tube pregnancy	5 (4.7)
Pre-pregnancy BMI (kg/m²)	<25	96 (90.6)	21.29±2.94
	≥25	10 (9.4)
Current BMI (kg/m²)	<25	59 (55.7)	25.17±3.68
	≥25	47 (44.3)
Smoking	Yes	3 (2.8)
	No	103 (97.2)
Multiple pregnancy	Singleton	103 (97.2)
	Twins	3 (2.8)
Previous experience of abortion	Yes	28 (26.4)
	No	78 (73.6)
Previous experience of delivery (number)	0	56 (52.8)
	1	30 (28.3)
	≥ 2	20 (18.9)
Type of pregnant woman	Gravida	66 (62.3)
	Parity	40 (37.7)
Gestation week^† (weeks)			28.17±6.75
Type of delivery^‡	Vaginal delivery	21 (52.5)
Previous admission history during pregnancy	Cesarean delivery Yes	19 (47.5) 18 (17)
	No	88 (83)
Chronic disease	Yes	5 (4.7)
	No	101 (95.3)
Previous experience of hearing on VTE	Yes	24 (22.6)
	No	82 (77.4)

M±SD=mean±standard deviation; BMI= body mass index; VTE=venous thromboembolism.

^† Respondents of gravida (N=66);

^‡ Respondents of parity (N=40).

Table 2.

Degree of Knowledge and Awareness for VTE (N=106)

Variables	Total score and subcategory scores	M±SD	Score range
Knowledge of VTE	Total score	4.47±4.29	0–15
	Understand and risks	0.46±0.86	0–3
	Symptom	0.73±0.99	0–3
	Diagnosis	0.35±0.66	0–2
	Prevention and treatment	2.93±2.50	0–7
Awareness of VTE	Total score	66.98±6.99	25–100
	Perceived sensitivity	11.70±2.16	5–20
	Perceived severity	12.58±2.64	5–20
	Perceived benefit	15.08±2.30	5–20
	Perceived disability	11.56±1.86	5–20
	Health motive	16.16±2.50	5–20

M±SD=mean±standard deviation; VTE=venous thromboembolism.

Table 3.

Difference between Knowledge and Awareness for VTE by Subject Characteristics (N=106)

Characteristics	Categories		Knowledge			Awareness
		M±SD	t/F/Z	p	M±SD	t/F/Z	p
Age (year)	25–29	6.79±5.48	2.45	.091	67.14±7.67	0.02	.976
	30–34	4.22±4.23			66.84±6.40
	≥35	3.97±3.67			67.14±7.74
Level of education	High school	3.67±4.29	0.62	.542	63.58±11.75	2.03	.136
	College/university	4.43±4.33			67.18±6.20
	Graduate school	5.64±4.06			69.18±5.23
Type of pregnant woman	Gravida	3.76±3.92	−2.25	.027	67.83±6.15	1.62	.107
	Parity	5.65±4.66			65.58±8.08
Previous experience of delivery (number)	0	3.71±3.90	2.40	.096	67.96±6.20	1.18	.312
	1	4.83±4.52			65.87±8.42
	≥2	6.05±4.70			65.90±6.99
Type of delivery^†	Vaginal delivery	5.33±4.90	−0.63	.531	65.76±9.81	−0.11	.913
	Cesarean delivery	6.00±4.47			65.37±5.87
Previous surgical experience history	Yes	5.39±4.33	1.31	.194	67.00±4.94	<0.01	1.000
	No	4.18±4.24			67.00±7.67
Chronic disease	Yes	6.40±4.83	1.03	.305	67.20±3.42	0.07	.943
	No	4.38±4.26			66.97±7.13
Previous experience hearing on VTE	Yes	7.75±4.97	3.89	.001	69.46±5.26	2.00	.048
	No	3.51±3.56			66.26±7.29
Pre-pregnancy BMI (kg/m²)	<25	4.63±4.31	1.14	.256	67.20±6.94	0.99	.325
	≥25	3.00±4.03			64.90±7.51
Current BMI (kg/m²)	<25	4.51±4.28	0.10	.922	67.88±5.78	1.49	.138
	≥25	4.43±4.34			65.85±8.19
Smoking	Yes	2.00±1.73	−1.01	.313	67.00±6.08	0.01	.996
	No	4.54±4.32			66.98±7.05
Religion	Yes	5.27±4.52	1.65	.101	66.78±6.81	−0.26	.798
	No	3,89±4.05			67.13±7.18
Job	Yes	4.91±3.67	0.72	.470	67.97±8.19	1.00	.319
	No	4.26±4.56			66.51±6.32
Multiple pregnancy	Singleton	4.47±4.31	−0.08	.937	67.03±7.06	0.41	.681
	Twins	4.67±4.16			65.33±4.51
Type of pregnancy	Twins Natural pregnancy	4.67±4.16 4.46±4.35	−0.18	.862	65.33±4.51 66.95±7.07	−0.20	.840
	Test tube pregnancy	4.80±3.03			67.60±5.77
Previous admission history during pregnancy	Yes	4.00±4.06	0.51	.611	69.83±6.24	−1.92	.057
	No	4.57±4.35			66.40±7.03

M±SD=mean±standard deviation; BMI=body mass index; VTE=venous thromboembolism.

^† Mann-Whitney U test.

Table 4.

Degree of Risk of Occurrence for VTE by Subjects (N=106)

Variables	Subarea	M±SD	Score range
Risk of occurrence	Total score	0.98±0.97	0–44
	Pre-existing risk factors	0.50±0.62	0–21
	Obstetric risk factors	0.29±0.62	0–11
	Transient risk factors	0.18±0.39	0–12

M±SD=mean±standard deviation; VTE=venous thromboembolism.

Table 5.

Frequency of Risk Factors for VTE by Subjects (N=106)

Risk factors for VTE	n(%)
Pre-existing risk factors 1. Previous VTE (except a single event related to major surgery)	0 (0.0)
2. Previous VTE provoked by major surgery	0 (0.0)
3. Known high-risk thrombophilia	0 (0.0)
4. Medical comorbidities, e.g., cancer, heart failure; active systemic lupus erythematosus,	0 (0.0)
inflammatory polyarthropathy or inflammatory bowel disease; nephrotic syndrome; type I diabetes mellitus with nephropathy; sickle cell disease; current intravenous drug user 5. Family history of unprovoked or estrogen-related VTE in first-degree relative	0 (0.0)
6. Known low-risk thrombophilia (no VTE)	0 (0.0)
7. Age (≥35 years)	36 (34.0)
8. Obesity	11 (10.4)
9. Parity ≥3	3 (2.8)
10. Smoker	3 (2.8)
11. Gross varicose veins	0 (0.0)
Obstetric risk factors
12. Pre-eclampsia in current pregnancy	0 (0.0)
13. ART/IVF (antenatal only)	5 (4.7)
14. Multiple pregnancy	3 (2.8)
15. Caesarean section in labour	5 (4.7)
16. Elective caesarean section	14 (13.2)
17. Mid-cavity or rotational operative delivery	0 (0.0)
18. Prolonged labour (≥24 hours)	0 (0.0)
19. PPH (>1 litre or transfusion)	0 (0.0)
20. Preterm birth <37⁺⁰ weeks in current pregnancy	1 (0.9)
21. Stillbirth in current pregnancy	0 (.00)
Transient risk factors
22. Any surgical procedure in pregnancy or puerperium except immediate repair of the	0 (0.0)
perineum, e.g., appendicectomy, postpartum sterilisation
23. Hyperemesis	1 (0.9)
24. OHSS (first trimester only)	0 (0.0)
25. Current systemic infection	0 (0.0)
26. Immobility, dehydration	18 (17.0)

ART=assisted reproductive technology; IVF=in vitro fertilisation; OHSS=ovarian hyper-stimulation syndrome; VTE=venous thromboembolism.

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