Nursing: Deep Vein Thrombosis in Pregnancy

• Nursing Care Management 109: Care for Mother and Child at Risk

Learning Outcomes

• Students will be able to discuss the signs and symptoms of Deep Vein Thrombosis (DVT).
• Students will be able to identify nursing care management for DVT.

Deep Vein Thrombosis (DVT)

• DVT occurs when blood clots form in the deep-seated veins and commonly occurs in the legs during pregnancy.
• Increased pressure or strain on the lower body during pregnancy can lead to DVT.
• Blood clots can have serious consequences if not attended to in time.

Why DVT Occurs During Pregnancy

• Hormonal changes can make the veins and valves smooth, leading to impaired functioning.
• Increased blood volume occurs while the number of veins remains the same.
• Significant weight gain occurs.
• Clotting factors in a woman increase in the final months, where clotting proteins can increase more than usual, causing blood cells to clump together and form clots in the veins.

Diagnosing DVT

• Doctors will inquire about symptoms and conduct a physical exam to check for swelling, tenderness, or changes in skin color.
• A D-dimer blood test helps measure a type of protein produced by blood clots.
• People with severe DVT usually have increased blood levels of D-dimer, and a normal test can help rule out pulmonary embolism (PE).
• Duplex ultrasounds use sound waves to create pictures of blood flow through veins and are standard for diagnosing DVT.
• Technicians use a transducer to gently move a small handheld device on the skin over the studied area.
• A series of ultrasounds may be performed over several days to check if a blood clot is growing or to check for new ones.
• Venography involves injecting dye into a large vein in the foot or ankle, using an X-ray to create an image of the veins to look for clots, but it is rarely performed due to being invasive.
• Magnetic Resonance Imaging (MRI) scans may be done to diagnose DVT in veins of the abdomen.

Clinical Manifestations

• Intense pain, cramping, burning sensation, and discoloration of the skin around the blood clot.

Risk Factors

• Doesn't pose any risk to the unborn baby unless any serious complications arise.
• Risk factors include carrying one or more babies, bleeding after delivery, fertility treatment, inherited blood clotting problems, being over 35 years old, Cesarean section, having another surgery or injury, smoking, prolonged sitting, certain medical conditions, cancer, or diabetes.

Goals of DVT Treatment

• Prevent clots from getting bigger.
• Prevent clots from breaking loose and traveling to the lungs.
• Reduce chances of another DVT.

Management

• The treatment of DVT during pregnancy is not complex however it requires consulting a hematologist, a vascular specialist, and a gynecologist.
• Doctors will prescribe anticoagulation therapy to dissolve blood and provide relief of systems.
• In anticoagulation therapy, Heparin and other injections may be administered and works prevent the current clot from growing, stops new clots from forming, and dissolves the existing clots by making the blood thinner.
• These injections may be required for the remainder of the pregnancy, and the therapy is stopped 2-3 weeks before delivery, but it may be resumed for about 6 weeks after delivery due to the risk of DVT postpartum.

Preventing DVT

• Avoid wearing heels and choose comfortable flat footwear to avoid excess pressure on veins and calf muscles.
• Stay hydrated, avoiding caffeinated and carbonated beverages that have dehydrating effects on the vascular system, making them prone to DVT.
• People with a history of DVT should consult a doctor and take preventive anti-coagulating medicines.
• Keep legs moving to ensure proper circulation of blood in the veins and prevent blood cells from clumping together.
• Compression stockings should be worn for 8-10 hours a day during pregnancy after consulting the doctor and removed while sleeping.