Postnatal Deep Vein Thrombosis (DVT)
Thrombosis or clot-formation within the veins is one of the potential complications
of pregnancy. When a clot is dislodged and transported within the bloodstream to
distant organs (usually the lungs), this is called thrombo-embolism. It can be a
serious - even fatal condition.
In the Western world, it is one of the leading causes of maternal death.
Deep vein thrombosis - commonly known by its short form, DVT - occurs in about 0.1
per cent of all pregnancies. It therefore means that, in an average general district
hospital, with an annual delivery rate of about 3000 babies, they will expect to
have three or four cases of DVT per year.
The risk of DVT increases with advancing pregnancy and is greatest in the early puerperium.
Overall, the risk of thrombosis in this period is roughly twice that during pregnancy.
It then gradually lessens. The veins usually affected are those in the lower limbs
(calf or thigh) and, to a lesser extent, the pelvic veins.
The risk of pelvic vein thrombosis is significantly increased by caesarean section.
Minimizing risk of thrombosis in the puerperium
A newly-delivered mother should endeavour to get on your feet quickly. This helps
reduce the risk of puerperal thrombosis. It is therefore imperative upon midwives
looking after new mothers to encourage them to ambulate as early as is practicable.
Mothers with confirmed increased risk of thrombosis such as those with thrombophilia
(discussed here) will usually be put on prophylactic anticoagulants, usually low-molecular
weight heparins (LMWH) during this period. This medication will be continued for
around 6 weeks, sometimes longer, depending on individual circumstances. This is
the case even if the person was not on anticoagulants during the pregnancy itself.
This is because the risk of thrombosis is highest in this (postnatal) period.
Treating Deep Vein Thrombosis (DVT) in the puerperium
A course of low molecular weight heparin injections will be commenced and this will
continue for several days, even weeks. The traditional heparin may be used but in
most cases doctors prefer to use the newer forms of what are known as "low molecular-weight
heparin" (LMWH). The brands used include Fragmin® (Dalteparin) and Clexane® (Enoxaparin).
They all do the same thing, but the administration regimes and monitoring are different.
The LMWHs have the convenience of being administered once or, at most, twice a day.
The patient may then be gradually switched to oral warfarin. Treatment will continue
for several weeks and in some cases, months. There will be regular clinical assessments
and occasional blood tests to monitor the progress.
While treatment will almost certainly be commenced in hospital, after the condition
has stabilized, treatment will continue on an outpatient basis. The patient is taught
to self-inject heparin or, alternatively, her partner may do this.
An additional measure will be the almost continuous wearing of special pressure stockings
(tights). These can be quite uncomfortable, but they are necessary especially if
the clot was in the lower limbs.
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