Pregnancy and thrombosis
The tendency for coagulation in the veins (venous) during pregnancy and postpartum period and associated pulmonary embolism (throwing the clot from the leg to the lung) increases tremendously.
This is one of the important causes of maternal deaths during pregnancy all over the world. Therefore, effective approaches according to risk factors during pregnancy are vital. In general, the risk of developing vein occlusion (DVT) during pregnancy is 3-5 per thousand. This is 5-10 times higher than non-pregnant women. In the postpartum period, this rate increases even more. 60% of vascular occlusion due to birth is observed in the weeks following birth.
Normally 8% of vein occlusions develop in the groin area, while this rate is 80% during pregnancy or postpartum period. The importance of the occlusions occurring in this region is that the risk of clot going to the lung is high due to the fact that it affects the entire leg seriously and is a mobile region.
Normally 55% of the obstructions are seen on the left leg. This rate rises to 80% in pregnant women or puerperant women. Therefore, severe swelling and pain from the groin to the heel are seen in the vein occlusions that develop during pregnancy or puerperium.
20% of deep venous thrombosis occurs in the first trimester, 33% in the second trimester, and 47% in the last trimester.
Risk factors for the development of deep venous thrombosis in pregnant women
- DVT history in close family members
- His/her history of thrombosis in the past: the risk of recurrence increases 3-4 times
- Age over 35
- Obesity (BMI> 30)
- Twin pregnancy
- Receiving treatment for pregnancy
- Insufficient fluid intake
- Genetic coagulation disorder: detected in 20-50% of thromboembolic events during pregnancy. It greatly increases the risk of clotting.
Isolated pulmonary embolism and silent DVT develop in 30% of pregnant women. Silent lung embolism develops in 40-50% of patients with DVT.
In general, one or all three important factors are involved in vascular occlusion. These factors are;
- Blood pilling in the leg due to immobility: One of the most important factors in blood pilling in the leg is the decrease in hormone-dependent venous tone (resistance), the compression of the enlarged uterus into the main toplarma (vena cava). Accordingly, a 50% decrease in vein flow rate is observed in the leg (25-30th week) and returns to normal in the 6th week after birth. 82% of DVTs after pregnancy and childbirth due to the compression of the main artery and uterus on the left leg in the left anatopes develop on the left leg.
- Intravascular injury: The layer called the endothelium, which lays the inner wall of the veins located in the abdomen, is injured due to compression and birth trauma during childbirth. Accordingly, more clot formation occurs in veins in the abdomen.
- Increase in coagulation factors, decrease in natural anticoagulation factors, decrease in coagulant dissolving activity. The main purpose of these mechanisms is to protect the mother from bleeding during and after birth.
SYMPTOMS AND FINDINGS IN DEEP VENOUS THROMBOSIS
- Pain (in the leg, hip, groin and abdomen)
- Leg pain with ankle movements
DIAGNOSIS OF DEEP VENOUS TROMBOZ IN PREGNANCY
In the diagnosis of deep venous thrombosis;
- Clinical evaluation
- Measurement of the level of D-dimer in the blood, which is a clot cleavage product
- Diagnosis can be made by venous Doppler ultrasound showing the clot.
- Computed tomography (CT) or ventilation / perfusion scintigraphy is performed in patients with suspected pulmonary embolism. However, magnetic resonance (MR) will be more suitable in cases before the 12th week when the fetus is sensitive to radiation.
MEASURES TO PREVENT DEEP VENOUS THROMBOSIS IN PREGNANCY
It will be beneficial to lie on the left side to reduce pressure on the main balls during pregnancy.
In high-risk patients, prophylactic anticoagulant therapy is initiated. Warfarin (coumadin), an anticoagulant drug taken orally, passes through plesanta. Accordingly, a large number of congenital anomalies may develop in the arms, legs and face in the first three months. Depending on the use in the last three months, intracranial bleeding develops in the baby. Therefore, the use of oral anticoagulant tablets (coumadin) is recommended in the second trimester. Anti-clot needles are used in very risky pregnant women in other months.
Following normal birth or cesarean, early mobilization is provided, compression stockings are used.
TREATMENT OF DEEP VENOUS THROMBOSIS IN PREGNANCY
In pregnant women diagnosed with deep venous obstruction, the legs should be raised above the heart level and an anticoagulant injection should be started to increase blood flow when lying or sitting.
In the early period, an elastic bandage can be applied from the ankle to the laptop area. Subsequently, below-knee medium pressure compression stockings should be worn. Socks should be worn for 1-2 years.
Patients should not lie still, they should perform their normal daily activities. The anticoagulant needle is cut 12 hours before birth, 12 hours after cesarean and 6 hours after normal birth. Anti-clot tablets can be used in the postpartum period, as they do not pass into breast milk.
In conclusion, it should be known that venous obstruction develops very frequently during pregnancy or postpartum period and causes fatal complications by throwing into the lung. In high-risk patients, preventive measures such as the use of a blood thinning needle and compression stockings must be taken.