Gynecology And Obstetrics-

Thrombosis in Pregnancy

introduction

The risk of thrombosis is significantly increased during pregnancy. A thrombosis is basically the blockage of a blood vessel with a blood clot. The blood coagulates and clots and the flow of blood can either be stopped completely or become significantly weaker. Usually this is vital so that injuries are closed quickly and the body does not lose too much blood. However, if this process happens inside the vessel, mostly in veins, blood congestion occurs, which can be dangerous. Thrombosis can occur anywhere in the body, but pregnancy usually affects the deep veins in the legs.

causes

The thrombosis that occurs in connection with pregnancy has specific causes and reasons. During pregnancy changed the Hormonal balance the expectant mother and so does the mother-to-be Composition of the blood. Also will increased the luteal hormone Progesterone releasedwhich is responsible for preparing the uterus for the egg cell to implant. For this, vessels and cells must be activated that will later supply the unborn child. Progesterone also stores water in the body. Under the influence of this hormone, the vessels expand clear and their walls become more elastic. The larger the diameter of the vessels, the slower the blood flow becomes. This fact is based on a physical law, the law of flow, which states that the flow is highest where the cross section is smallest.

In addition, the risk of getting a thrombosis again increases if you had one in a previous pregnancy. Also Inheritance plays a major role in this. If the mother or grandmother has already suffered as a result, this can continue in the younger generations. It's also important to mention that above all towards the end of pregnancy, the ever-growing Child presses on the abdominal veins and so the blood flow is also slowed down again. In addition, there are of course factors that are made worse by pregnancy. This means that if the patient had a certain risk of thrombosis before, this is only exacerbated by the pregnancy. This means that if Damage to the inner vascular skin exist before, a thrombosis develops even more easily. This damage can be caused, for example Smoke or Diabetes mellitus have arisen. Also Trauma can Injuries cause and thus weaken the vessel walls.It can also be congenital or acquired Vein weakness, such as Varicose veins Be risk factors. Inadequate exercise also promotes slowed blood flow. This situation occurs, for example, on a long-haul flight (Read about this: Can I fly while pregnant?). Those women should be advised of the dangers by the doctor from the start.

Symptoms

There are many thromboses that go unnoticed by those affected because they only last a short time and the thrombus dissolves on its own. But if this does not happen, it can multiple symptoms come, also depending on the location of the clot. But mostly it comes to one swelling and Redness, as well as a Warming of the skinwhich is in the immediate vicinity of the thrombus and the affected vessel. Since the affected vessel expands significantly, it often comes to one too Feeling of tension.

All of these symptoms can occur naturally if they are in high intensity Pain to lead. Another clue are increasing or developing painas soon as the appropriate extremity emotional becomes, for example, if you walk or move your legs while sitting. However, thick legs, for example, are not always an indication of a thrombosis. The extremities, especially the legs, often swell significantly, especially during pregnancy. Whether the suspicion is confirmed can only be judged by a doctor who should be consulted urgently if one has a suspicion.

How can you recognize a thrombosis during pregnancy?

Just because of the fact that you are pregnant, the doctor will be prudent. If the symptoms mentioned above appear, these are also strongly indicative of a thrombosis. So the doctor initially becomes one detailed anamnesis carry out. The aim of this is to discuss whether a possible earlier pregnancy already a thrombosis occurred and / or whether this widespread in the family is. There are also certain risk groups. It is also important to discuss whether the patient is only for a while little movement had, or even spent a lot of time in bed Has. This can also lead to a thrombosis.

After a physical exam, then the Sonography (Ultrasonic) is used for absolute clarity. This examination method is particularly suitable for Examine veins. More precisely, one means here the color-coded Doppler ultrasound. You can also use roentgen and Administration of contrast medium also recognize whether it is a thrombus. In addition to the CT / MRT, this examination is only used if the ultrasound does not provide any information. Also one Blood test is usually carried out. Here in particular the Clotting factors considered more closely. However, this type of examination is only an add-on and does not replace ultrasound.

therapy

As a rule, those affected with a Anticoagulant treated. These are drugs that the Prevent blood clotting, or reduce them. In pregnant women will often Heparin administered. Particular care must be taken here that the Medication does not cross the placenta , this means that they must not penetrate the placenta so as not to endanger the unborn child. When the blood clot has stopped, the body uses the body's own immune system to break down the remnants of the blood clot. Especially when the body breaks down the thrombus, there is an increased risk of thrombosis again. During this time in particular, it is important to ensure that anti-coagulant medication is taken.

It is important in the course of drug therapy that Regularly check coagulation values of the blood. An appropriate blood count must always be taken. In most cases, drug therapy is followed by one compression added. However, this depends on the intensity of the extremity to be compressed, as great pain can often arise. Also Mobilization is important, since the thrombus can grow more easily if the patient moves little and spends a lot of time lying down. Nevertheless, a lot depends on how severe the thrombosis is and how great the pain is for the person affected. Correct mobilization is often not possible at all and the patients have to stay in the hospital for some time. However, excessive movement can cause the thrombus to loosen mechanically and trigger a pulmonary embolism. So you should strictly follow the doctor's instructions.

forecast

The prognosis is actually good, provided that the clot is treated quickly and properly. However, it should be remembered that if you have further pregnancies you have an increased risk of developing a thrombosis again and you should be vigilant. If the thrombosis is not treated, it can spread to the lungs. The veins are the vessels that transport the oxygen-poor blood to the lungs in what is known as the pulmonary circulation, where the gas exchange takes place. This means that the inhaled air in the bronchi gets into the deoxygenated blood and the erythrocytes (red blood cells) are enriched with oxygen and the excess carbon dioxide can be exhaled from the body through the breath.

In this way, a blood clot can get lost in the lungs and get stuck there. If this happens, pulmonary embolism can occur. If the vessel is blocked, the pressure in the lungs increases dramatically. Since the right heart (i.e. the right half of the heart) is also part of the pulmonary circulation, the pressure usually also affects it, which can significantly impair the function or, in particularly bad cases, lead to a failure of the right heart. As a result, of course, the blood flow decreases and the oxygen supply is in some cases greatly reduced. This means that the organs are not supplied with enough blood, which can lead to functional restrictions and also to failure.

Another consequence of the reduced blood supply to the lungs can also be the death of tissue, which leads to permanently reduced lung function. The faster action is taken and the patient is treated in the hospital, the better the chances of survival and the better the chance that no long-term consequences will persist. You should definitely call an ambulance.

Another consequence of thrombosis can be post-thrombotic syndrome. This is persistent venous weakness preceded by the destruction of the venous valves. This disrupts the blood flow. A pulmonary embolism can be very dangerous, but not every thrombus automatically means that the consequences mentioned will actually happen. In any case, one should be careful.

prophylaxis

There are a few things that you can do yourself to reduce the risk of thrombosis during pregnancy. Lots of women pick up Compression stockings during pregnancy. It is important to mention that support stockings are not suitable for women with an increased risk of thrombosis, since they only serve healthy people to prevent tired and fat legs. However, they are far too elastic to protect against thrombosis. Compression stockings have the function that they are the Squeeze the veins and thus facilitate the closing of the venous valves again. In addition, the diameter of the vessels is reduced and the blood can flow quickly again. In addition, tissue fluid is pressed back into the veins and can thus be transported away.

Besides the compression stockings is also Move of great importance for the expectant mother. Standing or sitting too long causes the blood to sink into the legs. Likewise long lying. But if you move, it will Increased blood flow and thereby relieves the leg veins. It is generally very important that you enough liquid takes. During pregnancy, however, drinking takes on a much greater and more important role. If there is more fluid in the body, the blood is thinned and can thus improve its flow properties.

But care should be taken here not to Consume lots of dehydrating drinks or foods. Because these remove the important fluid from the body. Dehydrating foods include many teas, coffee, but also cucumber, pineapple, asparagus, tomatoes, celery, raw vegetables and potatoes. Should the patient still Smokeso should this ended and avoided if possible become. This is also one of the risk factors for thrombosis. In addition, this can also Elevate the legs something to help prevent too much blood from sinking into the leg veins.

Of course it is possible to prevent it already appropriate blood thinning medication to take. Low molecular weight heparin is ideal during pregnancy as it does not cross the placenta and so the unborn child is not at risk. However, whether such a drug is or can be taken preventively, must be attending physician determine and thus prescribe. For this it is important that initially discussed the risk of thrombosis through a conversation becomes.