article · Research and Practice in Thrombosis and Haemostasis
Venous thromboembolism is a primary cause of maternal death globally, but data from sub-Saharan Africa remain scarce. A retrospective case-control study conducted at a Tanzanian referral hospital examined clinical predictors and characteristics of pregnancy-associated venous thromboembolism between 2016 and 2024. Among 321 women, independent predictors identified were a prior history of venous thromboembolism, gross varicose veins, and stillbirth. Deep vein thrombosis accounted for nearly three-quarters of all cases, typically presenting as proximal and left-sided clots, while over a third of pulmonary embolism cases were severe or massive. Thromboprophylaxis use was extremely rare, received by less than three percent of patients and exclusively postpartum, while thrombophilia testing was virtually absent. These findings reveal major gaps in preventive care and clinical management within regional obstetric services.
Blood clots during and immediately after pregnancy are a leading driver of maternal mortality. Because the vast majority of affected women in this setting received no preventive therapies, identifying clear clinical predictors helps healthcare providers recognise high-risk patients earlier, enabling timely interventions that can prevent life-threatening complications and reduce maternal deaths.
This early-stage observational research supports the future development of context-specific clinical risk assessment tools, diagnostic protocols, and local guidelines for obstetric care providers. Any software, diagnostic pathway, or clinical decision tool based on these findings remains in the early research phase and requires validation through larger studies before real-world adoption.
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Background: Venous thromboembolism (VTE) is a leading cause of maternal mortality worldwide, yet data on pregnancy-associated VTE (PA-VTE) in sub-Saharan Africa remain limited. Objectives: This study aimed to identify clinical predictors and describe the phenotypic characteristics of PA-VTE in a Tanzanian referral setting. Methods: We conducted a retrospective case-control study at Muhimbili National Hospital from 2016 to 2024. Cases were pregnant or postpartum women (≤6 weeks) with objectively confirmed VTE. Controls were matched 1:2 on gestational stage. Due to sparse data in several matched sets, multivariable analysis was conducted using Firth penalized logistic regression to account for separation and small-sample bias. VTE cases were further characterized descriptively. Results: Of 321 women included (107 cases and 214 controls), independent predictors of PA-VTE were a history of VTE (adjusted odds ratio [aOR], 122; 95% CI, 2.66-43,361), gross varicose veins (aOR, 31.5; 95% CI, 5.98-306), and stillbirth (aOR, 15.2; 95% CI, 1.75-213), with wide CIs reflecting small-sample sizes. DVT accounted for 73% of cases, predominantly proximal and left-sided. Pulmonary embolism was submassive or massive in over one-third of cases. Only 2.8% of women received any thromboprophylaxis-all postpartum-and thrombophilia testing was rarely performed (3.7%). Conclusion: Traditional risk factors-particularly prior VTE, varicose veins, and stillbirth-remain highly relevant in this setting. Uptake of antenatal thromboprophylaxis was very low, highlighting major care gaps. While causality cannot be inferred, these findings underscore the need for larger studies to confirm risk associations and provide foundational evidence. Interventions should focus on developing local guidelines, strengthening clinician awareness, and integrating context-specific risk assessment tools into obstetric care in sub-Saharan Africa.
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DOI: 10.1016/j.rpth.2025.103195
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