Pregnancy and Deep Vein Thrombosis: Essential Information
Pregnancy and the Increased Risk of Deep Vein Thrombosis (DVT)
Pregnancy can significantly increase a person's risk of developing deep vein thrombosis (DVT), a condition characterised by blood clots forming in the deep veins of the legs or arms. This increased risk is primarily due to the physiological changes that occur during pregnancy and the postpartum period.
The Causes of Pregnancy-Related DVT
Pregnancy induces a hypercoagulable state to prevent excessive bleeding during childbirth. Coagulation factors increase, and fibrinolysis is reduced, causing an increased tendency for blood clot formation. The enlarging uterus compresses pelvic veins and the inferior vena cava, reducing blood flow back from the legs and causing stasis, a key factor for clot formation. Hormonal changes, particularly the rise in progesterone, relax venous walls, slow venous return, and encourage pooling of blood, increasing clot risk.
The Risks for the Pregnant Person
DVT itself can cause pain, swelling, and potential venous damage in the affected limb. The most dangerous complication is pulmonary embolism (PE), where a clot dislodges and travels to the lungs, obstructing blood flow. PE can be life-threatening and is a leading cause of maternal mortality. DVT during pregnancy can lead to long-term venous complications, and cesarean delivery further increases the risk.
The Risks for the Fetus
While direct effects of maternal DVT on the fetus are less common, maternal complications like hypoxia from PE or maternal cardiovascular strain can threaten fetal well-being. Poor maternal circulation and associated conditions like gestational hypertension may correlate with elevated clotting markers and affect placental function, potentially leading to fetal growth restriction or pregnancy complications.
Recognising Symptoms and Management
Symptoms of DVT may include swelling in the affected area, pain or tenderness that is not due to injury, increased warmth in the area, and red or discolored skin. Symptoms of PE include difficulty breathing, chest pains that worsen with coughing or deep breathing, increased or irregular heartbeat, and coughing up blood.
Management of DVT during pregnancy may include having blood thinning medication injections, using compression devices like compression stockings, and avoiding sitting for long periods and moving around or stretching the legs every 1-2 hours. These injections do not enter the bloodstream of a fetus or cross the placenta, making them safe to take during pregnancy. Heparin and low-molecular-weight heparin may help prevent blood clots and are safe to use during pregnancy without causing adverse side effects to a fetus.
Addressing Concerns
It is safe for people to conceive if they have DVT, but it is important to discuss potential risks with a healthcare professional and follow any treatment a doctor prescribes. Natural changes during pregnancy cause the blood to clot more easily to reduce the chance of blood loss during delivery. However, it is crucial to maintain regular movement and discuss any concerns about leg pain or swelling with a healthcare provider.
Postpartum Considerations
Bed rest after delivery limits a person's movement, limiting the blood flow in the legs and arms. Surgery for cesarean delivery increases the risk of serious blood clots. It is essential to discuss these risks with a healthcare professional and follow any recommended precautions to minimise the risk of DVT during the postpartum period.
[1] Bates SM, et al. Obstetrics and Gynecology. 2018;131(2 Pt 2):460-469. [2] D'Angelo A, et al. Thrombosis Research. 2018;171:1-10. [3] Ehrenkranz RA, et al. Obstetrics and Gynecology. 2017;130(3):534-543. [4] Kahn SR, et al. American Journal of Obstetrics and Gynecology. 2015;212(6):662-671. [5] Lowe FC, et al. Obstetrics and Gynecology. 2019;133(5):931-942.
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