Pregnancy is a life-changing phase in a woman’s life. A woman turns mature when she becomes a mother. But sometime the to be a mother may suffer from complications like vasa previa, ectopic pregnancy or thrombosis, etc. One of the most common types of venous thromboembolism is Deep Vein Thrombosis. Deep Vein Thrombosis (DVT) is a condition in which blood clots occur in the deep veins of the limbs or pelvis. Signs and Symptoms during deep vein thrombosis in limbs or pelvis include painful swelling, warmth, and redness of the affected limb.
A pregnant woman is five times more prone to deep vein thrombosis as compared to a non-pregnant woman. This is because there is an increase in blood clotting proteins and a decrease in anticlotting protein levels during pregnancy. Also, the enlarged uterus may increase the risk by applying additional pressure on the lower body blood flow while returning to the heart.
In this article:
A Guide for Deep Vein Thrombosis in Pregnancy
Symptoms of Deep Vein Thrombosis in Pregnancy
The most common symptoms as mentioned above are pain and swelling with tenderness in the affected leg usually the left leg is affected. Other symptoms of DVT are as follows :
- Extreme pain in the leg during walking or even during standing
- Pain exceeds when the foot is bent upwards towards the knee
- There is a rise in the temperature of the affected area which is felt warm.
- Redness of skin usually at the back of the leg specifically below the knee.
- Swelling varies, it can be slight to severe.
Differentiation between a muscle cramp and symptom of DVT
Muscle cramps are commonly seen during pregnancy. These muscle cramps are typically seen in the leg especially calf muscles are prone to undergo muscle cramp at night time in the second or third trimester of pregnancy. The cramps can be avoided by :
- Magnesium enriched supplements
- Comfortable and supportive footwear
Whereas, these preventive measures would not appear to be beneficial in pain DVT. Moreover, there is no swelling seen in muscle cramps.
Risk Factors of Deep Vein Thrombosis in Pregnancy
During pregnancy following factors tend to increase the risk of developing DVT :
- Varicose Veins (gnarl and enlarge veins)
- Multiple pregnancies
- Recurrent Urinary tract Infections
- BMI (Body Mass Index) equal to or greater than 30
- Inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis
- A woman above 35 years age
- Frequent hospitalization for non-delivery issues.
- Previous family history of DVT
There is even a high risk of developing DVT after delivery also known as postpartum DVT. The risk is associated with the following factors :
- Cesarean section delivery
- Postpartum infections
- Eclampsia or preeclampsia (Convulsions during pregnancy due to high blood pressure)
- Preterm delivery i.e. before completion of 36 weeks
- Any other underlying medical condition
When to See the Doctor?
As soon after the suspicion of DVT though it is not a medical emergency and may not even cause harm to the baby unless any serious complication occurs but it is better to visit a doctor early.
Diagnosis of Deep Vein Thrombosis in Pregnancy
DVT can easily be diagnosed in pregnancy by the symptoms itself. Doctors may recommend a blood test called a D-dimer test. This test identifies blood clot dispersed in the bloodstream. An ultrasound scan is a confirmatory diagnosis for DVT as blood clot occurrence increases during pregnancy.
A Doppler ultrasound is the best scan which helps in identifying the speed of blood flow through a blood vessel. If the blood flow has slowed down or stopped then this can be considered as a sign of a blood clot. Sometimes the Doppler ultrasound is not sufficient in confirming the DVT. Therefore, doctors may use a venogram. Here a contrasting dye is injected in the vein of the foot. The dye follows up in the leg which can be observed X-Ray. A pinpoint gap in the Flow as seen on the X-Ray represents the blood clot.
Treatment for Deep Vein Thrombosis in Pregnancy
DVT can be easily treated during pregnancy. To treat DVT, blood dissolving or thinning agents such as heparin is injected daily. Heparin :
- stops the clot to form a bigger clot
- helps in dissolving the clot
- Reduces the chance of further clots.
It is better to have regular checkups and blood tests to be sure that the clot has dissolved and no further clots are seen.
Deep Vein Thrombosis Effect on the Baby
DVT during pregnancy has no harmful effect on the baby unless any serious complication arises. Heparin is a safe drug to be used in pregnancy as it does not cross the placenta. But the injection of heparin needs to be stopped as soon as the labor begins or before 24 hours of induced labor. If injections are needed to be stopped during breastfeeding then warfarin tablet is taken to ensure the baby’s blood.
Complications of Deep Vein Thrombosis in Pregnancy
Long-standing DVT leads to permanent swelling of the veins and retention of fluid. In very rare cases, the clot migrates and gets lodged in the lungs resulting in Pulmonary Embolism.
Preventions of Deep Vein Thrombosis in Pregnancy
As such, there is no preventive measure to avoid DVT but the following steps can be taken to reduce the risk of developing DVT :
- Regular pregnancy-safe exercises
- Flight socks are to be worn in flight and walking for at least one hour daily is recommended
- Supported hose are to be wore
- Cessation of smoking
A preventive dose of heparin can be given to the women at high risk of DVT during the entire pregnancy or six to eight weeks postpartum.
Deep vein thrombosis is not common in pregnancy but is a serious condition that can be lethal if it gets lodged in the lungs. Awareness of the symptoms and risk factors is important to prevent DVT. Early treatment is helpful in ensuring the safety of the baby.
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