Why is the risk increased?
Doctors describe three conditions for blood clots: increased blood clotting, slow blood flow and damage to the vascular wall. Pregnancy provides all three. The level of coagulation factors increases already from the first trimester, the growing uterus compresses the pelvic veins and slows down the outflow from the legs, and during childbirth and caesarean section, tissue and blood vessels are damaged. That is why the greatest risk is not in the pregnancy itself, but in the first weeks after childbirth. Additionally, the risk is increased by hereditary coagulation disorders and previous thromboses.
- Physiological increase in coagulability
- Compression of the pelvic veins by the uterus
- Slowing of venous outflow
- Damage to blood vessels during childbirth and surgery
- Hereditary thrombophilias
- Personal and family history of thrombosis
- Obesity, inactivity, long flights
How to recognize deep vein thrombosis
The main difference from ordinary edema in pregnant women is asymmetry. Physiological edema is usually symmetrical, appears in the evening and decreases after resting with elevated legs. With thrombosis, one leg swells, and the swelling does not go away overnight and is accompanied by bursting pain, a feeling of heaviness, pain along the vein or in the calf muscle. The skin may be red, warm to the touch, and the subcutaneous veins become more visible. Pelvic vein thrombosis causes pain in the lower abdomen, groin and thigh with swelling of the entire leg.
- Swelling of one leg that does not go away overnight
- Bursting pain and heaviness
- Calf pain when pressed
- Redness and local fever
- Strengthening the pattern of saphenous veins
- Pain in the groin and thigh due to pelvic vein thrombosis
Pulmonary embolism
This is the most dangerous complication, in which a fragment of a blood clot enters the pulmonary vessels with the bloodstream. The condition develops suddenly: lack of air, chest pain that gets worse with inhalation, rapid heartbeat, sometimes a cough streaked with blood, severe weakness and fainting. Pregnant women and postpartum women often attribute shortness of breath to pregnancy or fatigue, wasting time. If you have such symptoms, you should immediately call an ambulance by calling 103 and do not try to get to the clinic yourself.
- Sudden shortness of breath
- Chest pain when inhaling
- Rapid heartbeat
- Cough, sometimes with blood
- Fainting and severe weakness
- Immediate call for ambulance 103
Diagnostics
The main method is ultrasound examination of the veins of the lower extremities with Dopplerography: it is safe during pregnancy, accessible and allows you to see a blood clot and assess the patency of the veins. The analysis of D-dimer during pregnancy is interpreted with caution, since its level naturally increases as the period increases, and an increased result in itself does not mean thrombosis. A coagulogram helps evaluate the coagulation system. If pulmonary embolism is suspected, chest imaging methods are used, choosing those that give the least radiation dose.
- Ultrasound of the veins of the lower extremities with Dopplerography
- Coagulogram
- D-dimer based on gestational age
- General blood test
- Lung imaging for suspected embolism
- Testing for thrombophilia according to the doctor's decision
Treatment and prevention
Treatment is carried out with anticoagulants allowed during pregnancy; They are prescribed by a doctor, selecting the dose according to weight and situation. Some medications used outside of pregnancy are contraindicated, so independent replacement is unacceptable. Therapy is usually continued in the postpartum period. Treatment is supplemented with compression hosiery of the required class, which is selected individually, and early activation. Prevention is especially important for women at risk: they may be prescribed preventive therapy during pregnancy and after childbirth, especially during cesarean section.
- Anticoagulants allowed during pregnancy
- Individual selection of compression hosiery
- Early activation and walking
- Drinking enough
- Breaks and leg exercises during long flights
- Preventive therapy in risk groups
- Continued monitoring after birth
