Deep Vein Thrombosis (DVT) in Pregnancy

Deep vein thrombosis (DVT) is a blood clot significantly more common in pregnant women and can lead to a more serious condition called pulmonary embolism (PE). Fortunately, DVT and PE are treatable and even preventable among women who are more at risk. Most mothers with blood clotting conditions have a completely healthy pregnancy and delivery. Deep vein thrombosis occurs when a blood clot forms in one or more veins deep in the body.

These clots usually start in the legs but can also affect the pelvis or arms. Blood clots are treatable and often preventable. According to the Centers for Disease Control and Prevention (CDC), pregnant women are five times more likely to develop deep vein thrombosis than non-pregnant women. This risk persists for up to three months after the baby is born. Pregnant women should be aware of the link between pregnancy and DVT because an untreated clot can be released and move through the bloodstream.

Symptoms

The most obvious sign of DVT is severe swelling and pain or tenderness in one of the legs. Up to 90% of DVT cases occur in pregnancy in the left leg. Other symptoms of DVT include:

Pain in the leg when standing or moving around
Pain in the leg that gets worse by bending the leg towards the knee
Slight to severe swelling
Red skin at the back of the leg, typically below the knee
Warm skin in the affected area

Risk factors

Out of every 1000 pregnant women, only one woman gets a blood clot. But in addition to pregnancy, some other cases increase the risk of DVT. Risk factors include:

Smoking
Bed rest
Long-distance travel
Certain medical conditions, including heart disease, cancer, and diabetes
Previous blood clots
Having another surgery or an injury
Taking birth control pills
Having hormone replacement therapy
A body-mass index (BMI) of 30 or higher
Carrying more than one baby
A long labor
Bleeding after delivery
Fertility treatments that use hormones
Having an inherited blood-clotting disorder
Being over 35
A family history of DVT
Delivering by C-section

How common is deep vein thrombosis (DVT)?

Venous thromboembolism, which includes deep vein thrombosis and pulmonary embolism, occurs two in 1,000 pregnancies. While these numbers make it a relatively uncommon complication, VTE occurs in pregnant women about four to five times more often than other women of the same age and 20 times more often in the six weeks after birth. In the eighth week after delivery, the risk of DVT returns to normal.

DVT is more common during pregnancy because the body naturally wants to limit bleeding during childbirth. Experts know that blood clotting proteins increase during pregnancy while anti-clotting protein levels decrease. Other factors that can contribute to DVT during pregnancy may include uterine enlargement, which increases the pressure on the veins that return blood to the heart from the lower body and immobility due to more rest.

Can DVT harm the baby?

Most of the time, the body breaks down the blood clot before it causes serious problems. But when the woman is pregnant, the risk of the clot getting bigger and breaking is higher. It can then travel through the bloodstream to the lungs. Doctors call this disease pulmonary embolism (PE). Blood clots can also cause:

Heart attack
Stroke
Miscarriage
Premature birth
Intrauterine growth restriction

Blood clots can also form in the placenta, the organ that supplies blood to the baby. This is more common in women at higher risk for developing blood clots, resulting in miscarriage or stillbirth.

Prevent pregnancy blood clots

Pregnant women and mothers are at risk for DVT because they are pregnant or postpartum, and this risk cannot be eliminated. But there are steps a woman can take to reduce the risk of blood clots.

Keep moving

If the mother is overweight and sedentary, this affects blood flow and increases the risk of deep vein thrombosis during pregnancy. Therefore, mothers should stay active and maintain their weight during pregnancy. If mothers have to rest in bed because of an injury or complication during pregnancy, the doctor may prescribe blood thinners as a precaution.

Get up during travel

Flight in itself is a risk factor for DVT, so pregnant women who board the plane are definitely at greater risk. If a pregnant woman has to fly, she should get up and move every hour or two and do ankle roll exercises while sitting. The same instructions are required when traveling by car or bus.

Wear compression stockings

Because compression stockings help improve blood circulation and reduce swelling in the legs, they can reduce the risk of deep vein thrombosis in pregnancy.

Drink lots of water

Staying hydrated during pregnancy helps prevent blood clots by preventing the blood from becoming too thick. Women should drink ten glasses of fluids daily during pregnancy and 12 to 13 glasses daily during breastfeeding.

Foods on a deep vein thrombosis prevention diet

There is no specific diet to prevent deep vein thrombosis, but the risk can be reduced with diet.

Olive oil

Eating virgin olive oil may reduce platelet activity and thus reduce the risk of dangerous clots in the leg.

Fresh vegetables

Vegetables add a healthy dose of fiber and antioxidants to the diet, improving overall heart health and reducing the risk of Deep Vein Thrombosis.

Fresh fruits

Eating a variety of fresh fruits contributes to heart health. People who eat five servings of fruits and vegetables a day reduce their risk of developing thrombosis by half compared to people who eat less than three servings a day.

Lean proteins

People at risk for thrombosis should increase their intake of fish and poultry while reducing their intake of fatty meats such as beef and pork. Eating fatty meats can cause high cholesterol, which increases DVT risk.

Diagnosis

To diagnose Deep Vein Thrombosis, the doctor will ask about symptoms. It also performs a physical exam to check for swelling, sensitivity, or discoloration of the skin. Tests used to diagnose or rule out blood clots include:

D-dimer blood test: D dimer is a protein produced by blood clots. Almost everyone with severe DVT has high blood levels of D-dimers. A natural result in a D-dimer test can often help rule out PE.
Duplex ultrasound: This type of ultrasound uses reflective sound waves to observe blood flow in the arteries. This diagnostic tool helps the doctor assess the blood flow condition in the main arteries and veins, such as the arms, legs, and neck. Duplex ultrasound can diagnose decreased flow or obstruction of the main vessels.

This ultrasound produces a visible image using sound waves; sound waves return from the blood vessels. Sounds are also converted into graphs using a computer program to assess blood flow direction and velocity. Sometimes, a series of ultrasounds are done over several days to determine if a blood clot is growing or check for a new clot.

Venography: Venography is an experiment that uses X-rays to check the health of blood vessels, especially in the legs. During lower extremity venography, the doctor injects a contrast agent into the arteries to check how the blood is flowing in arteries.

Natural venography means that the blood flow inside the arteries is normal. But abnormal venography means that something is blocking blood flow in the arteries. Based on the results, the doctor decides on further examinations or treatment. This test is invasive, so it is rarely done.

Magnetic resonance imaging (MRI) scan: Magnetic resonance imaging (MRI) is a medical imaging technique that uses a computer-generated magnetic field and radio waves to create accurate images of body organs and tissues. This test may be done to diagnose DVT in the abdominal veins.

Treatment

There are three main goals for treating Deep Vein Thrombosis, including:

Preventing clot enlargement
Avoiding breaking the clot and going to the lungs
Reducing chances of another DVT

Blood thinners

Deep Vein Thrombosis is usually treated with anticoagulants, also called blood thinners. These drugs do not break down existing blood clots, but they can prevent the clots from getting bigger and reduce the risk of developing more clots. Blood thinners may be taken orally or IV or by subcutaneous injection. Heparin is normally given by IV. After taking a blood thinner for a few days, the doctor may recommend taking the pill. Examples of blood thinners include warfarin and dabigatran.

Some blood thinners do not need to be given intravenously or by injection. They can be started immediately after diagnosis. A pregnant mother may need to take blood-thinning pills for three months or more. It is important to take them exactly as prescribed to avoid serious side effects. If warfarin is taken, regular blood tests are needed to check the duration of the blood clot. Pregnant women should not take certain blood thinners.

Clot busters

These drugs, also called thrombolytics, may be prescribed if women have a more serious DVT or PE or if other medications do not work. These drugs are given either through the IV or through a tube (catheter) that is inserted directly into the clot. Clot busters can cause serious bleeding, so they are usually only used for people with severe blood clots.

Filters

If it is not possible to use drugs to dilute the blood, a filter may be inserted into a large vein in the abdomen to prevent clots in the lungs.

Compression stockings

These special socks reduce the possibility of accumulation and blood clotting. To help prevent swelling associated with deep vein thrombosis, wear them on feet from foot to knee.

In the case of cesarean delivery

If a cesarean section is needed, the last heparin injection should be 24 hours before delivery. Heparin is usually restarted within 4 hours after surgery. If the baby needs an emergency cesarean delivery within 24 hours of the last injection, no epidural or spinal injection can be given. Instead, general anesthesia is necessary for the operation.

The bottom line

Women may be aware of some pregnancy complications, such as gestational diabetes and preeclampsia. But there is a relatively common pregnancy complication that Women should be aware of, as it can lead to serious consequences. The body’s veins carry blood back to the heart from different parts of the body. Sometimes a blood clot can form in one of the veins called “venous thrombosis.”

The most common blood clot in pregnancy is called “deep vein thrombosis” or “DVT”. More than 90% of DVT cases occur in the left leg. The clot is located inside a deep vein under the skin and can be seen on the back of the foot, leg, or pelvis. Fortunately, venous thrombosis and pulmonary embolism are treatable and can be prevented in women with risk factors.

Additional questions

1. Does thrombosis affect the next pregnancy?

If a woman has DVT during her pregnancy, she is more likely to get it in her next pregnancy. One in 10 women gets another DVT, but this depends on the cause of the thrombosis. It is unlikely to recur if this complication is due to a complication that no longer affects the person.

2. Does DVT go away on its own?

Deep vein thrombosis usually occurs in the leg. It often disappears unnoticed and resolves on its own. But it can cause symptoms such as pain and swelling. If a person is diagnosed with DVT, they need treatment to prevent serious complications such as pulmonary embolism.

3. Does DVT hurt more when lying down?

The fluid that builds up in the lungs can cause shortness of breath, which is a sign of a pulmonary embolism. Symptoms usually get worse when lying down.

4. Is massage good for DVT?

When a person is being treated for Deep Vein Thrombosis, she should not massage her feet because massage could cause the clot to break loose.

5. When should worry about varicose veins in pregnancy?

Contact the doctor if the veins feel hard, hot, or painful or if the skin on them looks red. Varicose veins often heal better after delivery.