A medical condition where a patient has clot formation in the veins of either the legs or pelvis is collectively called thrombotic disease. Clot formation may be caused by venous stasis or diminished blood flow.
However, a thrombotic disease which occurs either due to infection or trauma to the veins is known as thrombophlebitis.
Thrombophlebitis is a clot formation in an inflammed veins. Remember, pregnancy is a coagulable state due to changes in clotting factors caused by pregnancy hormones.
While the one that occurs due to clot formation in the absence of infection is termed as phlebothrombosis. The clot in phlebothrombosis is attached at one end to the wall of the vein (i.e. in a manner similar to weed in water) thereby increasing tendency of fragmentation and embolism.
Puerperal mother with Septic thrombophlebitis often presents with spiking fever and chills. Postpartum pelvic infection contributes to the causes of Septic thrombophlebitis apart from bacteria such as facultative streptococci, staphylococcus aureus, anaerobic streptococci, Escherichia coli and bacteriodes species.
Risk factors for thrombophlebitis
The following factors tend to increase the chances of developing thrombophlebitis:
- Advanced maternal age ( 40 years and above)
- Prolonged bed rest during pregnancy
- Those who have used hormonal contraceptive prior to getting pregnant
- Women with jobs requiring a long period of sitting down
- Anaemic heart diseases
Types of thrombophlebitis
Superficial vein thrombosis (SVT): This occurs in the superficial veins of the woman’s legs. It is attached to the veins firmly. SVT is unlikely to break off and travel to rest of the body during 3-4 days postpartum period
Signs and symptoms of superficial vein thrombosis
- reddened, warm and swollen area over the clot
- palpable and very tender veins
- No need for anticoagulant therapy
Deep vein thrombosis (DVT): DVT occurs in the large veins usually without inflammation. Clot is far more likely to break off and travel to the lungs, causing pulmonary embolism — which is a very fatal complication.
Signs and symptoms of Deep vein thrombosis
These include the following:
- Low grade pyrexia(fever)
- paleness or swelling of the affected leg
- Homan’s sign (i.e. pain in the calf on dorsiflexion of the foot) which is a positive sign of Deep vein thrombosis
- Ultrasound scanning would confirm its diagnosis
- DVT is a serious condition and hence, requires anticoagulant therapy and other supportive care such as bed rest, analgesia and close monitoring.
Early diagnosis and treatment reduces the risk of emboli and gradually takes 4-6 weeks to resolve completely.
How to treat thrombotic diseases
The treatment of the thrombotic diseases during pregnancy, labour or puerperium is based on identifying the causative factors and providing appropriate treatment. Commonly used medication is heparin especially in pregnancy it’s only safest anticoagulant. The patient is advised on the need for regular ambulation or exercise and good nutrition.