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though the s Ubject o f i nteres t i s ma inly pu erperal thrombo ­
phlebit is, puerperal t hrombos i s is reviewed qe ne r-e Lj.y ,
Th r ombosis in the lower extremi t ies i s also classified
by whethe r it i nvolves su perficial ve ins or deeps ve i ns [132} .
In stud ies in the dev eloped world, reporte d incidences of
s uperfi cial and deep vein thrombosis during pregna ncy a nd the
puerperi um range from O.4%: to 1. 4\ of deliverie s ( 132-137] .
Patients wi t h or-iy s uperficial v e i n t hrombosis, have l o we r
risk for pu l mo na r y embolism, but about 17% of them have
associated d e e p vein t h r o mbo s i s whi c h i ncreases t he risk
[135] . I n Tecumsah, United states t he combined incidence of
d eep vein thrombosis a nd pulmonary embo lism was observed by
Coon at al ., to be 1 i n 200 deliveries or 5.9 per 1000
pregnancies ( 137 ] , a r a t e similar t o that i n the Nethe r l a nds
study (134) .
Desp i t e the l ow inc i d en ce, t h ro mboembolic disease ra nks
highly as an important ca use of mat ernal mortality i n the
developed world [4 1,131). I n England a nd Wales , for example ,
wi th a reported Lnc.idence of 0.7 per 1000 de liveries it was
observed t o be t he second most important cause of materna l
death from 1979 - 198 1 (131 ).
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On t h e ot he r han d, it r an ks a s a much l e s s important
ca use of maternal mo r t alit y i n the poor co unt ries. In
Men oufia , Egyp t (10 ), and Uganda [36], f o r example, i t
accounted f or only one percent of a l l maternal deaths , and t wa