Blood Clots and Pregnancy
Blood clots and pregnancy is the added complication that could happen to the pregnant woman along with other pregnancy complications such Polyhydramnios, Oligohydraminos, Urinary tract infections, Backache, Nausea, Vomiting, Pain abdomen, etc. It’s not something that’s talked about a lot for pregnant patients, so they tend to not be aware of it.
Women who have experienced a blood clot in the past, especially if it was related to estrogen-based birth control, need to take certain precautions when pregnant or planning to become pregnant.
During pregnancy and the immediate period after birth, the risk of venous thrombosis is increased. Your risk of developing a thrombosis will be assessed in pregnancy and after the birth of your baby.
Symptoms showing you are at risk
Know the signs and symptoms of blood clots
• A blood clot occurring in the legs or arms is called deep vein thrombosis (DVT). Signs and symptoms of a DVT include
▪︎ Pain or tenderness not caused by injury
▪︎ Swelling of the affected limb
▪︎ Skin that is warm to the touch, red, or discolored
Blood clots to the lung, which are more common following delivery, manifest as experiencing chest pain, coughing (including coughing up blood), and fainting.
If you have these signs or symptoms, alert your doctor as soon as possible.
• Pregnant women are prone to developing pulmonary embolism (PE) and deep vein thrombosis (DVT), but they also can get pelvic vein thrombosis. Pelvic veins are the veins that go to the legs but are higher up. Those can thrombose and cause massive leg swelling. Pregnant women can also get blood clots in the ovarian veins. These can cause abdominal, pelvic, or side pain.
• Much like birth control, pregnancy increases a woman’s chance of experiencing a blood clot because her estrogen levels are higher than normal. Blood also becomes more prone to clotting during pregnancy, because the body is preparing to give birth. When you give birth, there’s bleeding. Your body is going to be a bit more inclined towards clotting so that you can heal up and stop bleeding.
Who needs anticoagulation therapy?
• Women who have had a blood clot in the past and are on anticoagulation will need to continue their anticoagulation during pregnancy.
• Most women who have had a blood clot in the past, but are not currently on anticoagulation, will need to be restarted on anticoagulation during pregnancy.
• Women who develop a blood clot during pregnancy will need to be started on anticoagulation.
Any pregnant woman is at increased risk of developing a blood clot. However, some women have additional factors that put them at increased risk.
Factors specific to pregnancy include
• having a C-section delivery.
Prolonged bed rest, say for preterm labor or premature rupture of the membranes, also will add additional risk.
Other general conditions that increase a pregnant woman’s risk include
• age over 35,
• being obese
• being a smoker
Women who have a known genetic predisposition for developing clots are at the highest risk during pregnancy.
The diagnosis for blood clots and pregnancy is fairly straightforward, depending on what we are suspicious of. We use an ultrasound to examine the flow of blood through the legs and to check for any blockages. Magnetic resonance imaging also can be useful. Special CT tests look for blood clots in the pulmonary vessels.
Best choice for anticoagulation therapy in pregnancy
Standard or “unfractionated” heparin (UFH) and low-molecular-weight heparin (LMWH) are safe in pregnancy because they do not cross the placenta and, therefore, do not enter the bloodstream of unborn babies. In fact, in women who have thrombophilia, heparin or LMWH may improve the outcome of pregnancy in women who have had a previous pregnancy that was complicated by severe high blood pressure of pregnancy (severe preeclampsia).
Whether women are treated with heparin, or LMWH, they will ultimately need to receive once or twice-daily injections until at least 6 weeks after delivery of the baby.
Does the anticoagulation therapy need to continue around the time of delivery?
• Low molecular weight heparin (LMWH), if it is in the mother’s system at the time of childbirth, or when an epidural or spinal anesthetic is placed, may increase the risk of bleeding complications. Therefore, the LMWH is held 24 hours before anticipated delivery. LMWH can be resumed after delivery.
• Heparin, which is shorter acting, can be used during the last few weeks of pregnancy and held a few hours before delivery.
• Women can remain on LMWH for the duration of their anticoagulation, or until one to two weeks postpartum
Safety concerns for the baby with anticoagulation therapy!
Heparin injections are safer for the baby because this medication does not cross the placenta into the baby’s circulation. If you are already on Warfarin and you think you may be pregnant, it is a good idea to do an early pregnancy test and stop the Warfarin as soon as possible.
Usually, warfarin should not be used when you are pregnant. Heparin injections can be used safely throughout the pregnancy but require you to inject yourself every day.
Side Effects of anticoagulation therapy for the pregnant women
Side effects of heparin include:
• There may be an increased tendency to bleeding.
• Bruising at the injection site.
• Slightly increased risk of a bruising (wound hematoma) if having a cesarean birth.
• Very rarely there may be allergic-type reactions at the injection site or in the body generally, increased blood potassium level, an immune reaction called HIT (heparin-induced thrombocytopenia), or possibly bone thinning.
Monitoring for these is part of your clinic visit, but the more serious side effects are rarely seen with low molecular weight heparin (LMWH) use in pregnancy.
Preventive Measures to be followed after delivery
It’s important to continuing moving once you get home as well. We aren’t asking that you start an exercise routine immediately – walking to the bathroom, going to a chair to hold your newborn, and moving around your home, in general, is all it takes to reduce your risk of developing a blood clot. Women at particular risk, including those with a history of blood clots or those who developed clots in the hospital, might need additional measures to prevent the development of blood clots.
Pregnancy and the weeks following delivery are high-risk times for developing blood clots, which can cause serious health problems if not detected early. But with proper interventions, more women can reduce the risk of dangerous blood clots related to pregnancy.
For more informative articles on pregnancy and other health issues, please visit our website www.santripty.com and also feel free to consult.