Thrombophlebitis in pregnancy

Thrombophlebitis during pregnancy is a common pathology both in women with a complicated background of thrombophlebitis and in women who are facing this problem for the first time. This is explained by physiological changes in the woman's body during pregnancy, the peculiarities of the circulatory system during this period. This pathology can lead to various complications of pregnancy and the process of childbirth. It is necessary to promptly correct the rheological properties of the blood in case of this pathology even before pregnancy and treat this disease during pregnancy.

Causes thrombophlebitis in pregnancy

What is the danger of thrombophlebitis during pregnancy? This question worries many women, and there is a good reason for this. There may be serious complications, both during childbirth and in the early postpartum period, which threaten the life of a woman and can cause a septic condition.

Pregnancy is a period in a woman's life when all internal organs adapt to the development of the fetus and its vital functions. The same changes occur with the hematopoietic system. As a mechanism for compensating for the expected bleeding during childbirth, the rheological properties of the blood change. In this case, blood thickening is observed, which is characterized by an increase in the number of formed elements of the blood, including platelets, as well as an increase in the level of fibrinogen, prothrombin and other plasma coagulation factors. This condition primarily ensures an increase in the oxygen function of the blood to provide a sufficient amount of oxygen for both the mother and the child, and also increases the potential for preventing previous physiological bleeding during childbirth. This is the basis for deterioration of blood flow in the veins and the formation of blood clots, and in the presence of other risk factors, this can become the basis for thrombophlebitis.

Risk factors for thrombophlebitis during pregnancy include:

1. excessive body weight, which impairs the outflow of blood through the veins due to the anatomical features of the location of the venous vessels;
2. insufficient physical activity, as well as a sedentary way of working - this reduces the tone of the veins and impairs the outflow of blood through them, resulting in the formation of edema;
3. cardiovascular diseases, which are accompanied by a deterioration in the pumping function of the heart and the formation of edema, which contributes to a mechanical obstruction to the outflow of blood;
4. complications of pregnancy in the form of early gestosis;
5. taking contraceptives or other hormonal agents before pregnancy.

All these factors, in the presence of physiological thickening of the blood, contribute to the development of thrombophlebitis during pregnancy. Therefore, the main cause of the development of this pathology should be considered the physiological characteristics of the circulatory system of a pregnant woman in combination with the risk factors for this pathology.

Also, the causes of thrombophlebitis development during pregnancy can be considered infectious diseases of the woman, previous surgical interventions, varicose veins of the lower extremities, injuries, local inflammatory processes, allergic reactions.

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Pathogenesis

To clarify the pathogenesis of thrombophlebitis development during pregnancy, it is necessary to analyze some features of this process. It is necessary to clearly distinguish two main concepts - thrombophlebitis and phlebothrombosis. Phlebothrombosis is the formation of a thrombus in the wall of a vein that is intact, that is, without an accompanying inflammatory process in it. Thrombophlebitis is a disease of the veins of the systemic circulation, which is characterized by the formation of a thrombus in their lumen with inflammation of the vascular wall.

The pathogenesis of thrombophlebitis has several stages. First of all, there must be local changes in the vein wall in the form of injury to the inner lining and damage to its integrity. This is accompanied by a violation of local blood flow in this place due to the fact that there is a swirl of blood flow. A pregnant woman's blood is thicker, which contributes to even more pronounced blood stasis in this place, and an increased amount of coagulation factors in the blood of a pregnant woman contributes to the fact that there are all the conditions for the formation of a thrombus. In this case, there are all the conditions for blood stasis, thrombus formation, and the presence of any infectious process in the body induces a whole complex of reactions for the formation of thrombophlebitis. If a woman suffered from venous system pathology before childbirth in the form of varicose veins of the lower extremities, then such violations of anatomical features further contribute to the formation of thrombophlebitis. Often, thrombophlebitis develops in the early postpartum period and this is considered a postpartum septic condition.

Depending on the localization, which is most common during pregnancy, a distinction is made between deep and superficial vein thrombophlebitis - respectively, thrombophlebitis of the veins of the small pelvis and lower extremities.

Taking these features into account, it must be said that the risk group includes women with a corresponding anamnesis and this requires preventive measures even before pregnancy.

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Symptoms thrombophlebitis in pregnancy

Thrombophlebitis during pregnancy in the presence of varicose veins is more often localized in the veins of the lower extremities, and in the early postpartum period, thrombophlebitis of the pelvic veins is more common.

The first signs of thrombophlebitis during pregnancy may appear in the later stages, when the changes are most pronounced, which is explained by the increase in the body weight of the pregnant woman, and the decrease in motor activity, and rheological changes in the blood.

Thrombophlebitis of the veins of the lower extremities has a milder course, since the localization of the process allows for timely diagnosis of the disease. In this case, the symptoms of this disease are as follows: hyperemia of the inflamed vein appears, a local increase in the temperature of the skin above it, local pain and swelling of the soft tissues along the vein. With local palpation of the affected vein, the pain intensifies. These symptoms are further accompanied by systemic manifestations of the inflammatory process in the form of intoxication syndrome - body temperature may increase, headache and pain throughout the leg appear, performance decreases and the general condition worsens. If women have concomitant varicose veins of the lower extremities, then such veins will be dilated, blue, branched. Such symptoms are very dangerous for a pregnant woman, since this condition worsens the nutrition of the fetus and its growth.

Thrombophlebitis in the groin during pregnancy is less common, but it manifests itself with similar symptoms - pain, local hyperemia, hyperthermia, tissue edema. At the same time, due to the localization of this process, it is necessary to conduct differential diagnostics with inguinal hernia.

If thrombophlebitis is localized in the veins of the pelvis, then this is a more serious pathology due to the complexity of diagnosis and the possibility of developing rapid complications.

Thrombophlebitis of the pelvic veins often occurs in the early postpartum period, especially in women with a cesarean section. In this case, the woman feels a sharp pain in the abdomen or pelvis, the manifestations of the intoxication syndrome increase - body temperature, nausea, vomiting, headache. During the examination, sometimes in the case of a close localization of the venous node, it is possible to palpate a painful seal. This allows one to suspect thrombophlebitis and requires immediate action.

These are the main symptoms of thrombophlebitis during pregnancy, which allow one to suspect a pathology and take urgent measures.

Complications and consequences

Complications of thrombophlebitis during pregnancy can be quite serious if not diagnosed or treated in a timely manner. Thrombophlebitis of the veins of the lower extremities can result in acute venous insufficiency, thromboembolism of the systemic circulation, floating thrombus, and acute phlebitis. If the process affects the veins of the small pelvis, then the septic process spreads with the threat of thrombosis of the inferior vena cava.

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Diagnostics thrombophlebitis in pregnancy

Diagnosis of thrombophlebitis during pregnancy should be as early as possible for timely treatment and prevention of complications. To do this, if any symptoms appear, you should consult a doctor.

Diagnostics should begin with a thorough collection of anamnestic data. In this case, it is necessary to detail the complaints and clarify when the disease first began, how the symptoms developed, whether there are systemic changes. It is also necessary to find out whether the woman has a history of varicose veins of the lower extremities. Then you need to examine the legs and determine the condition of the superficial veins and the presence of edema.

Tests are an important indicator for diagnosing thrombophlebitis during pregnancy, as well as for monitoring the main indicators of the pregnant woman's condition. General and special tests are carried out - a general blood test with determination of platelets, general urine and feces analysis, biochemical blood test. Changes in the form of an increase in hematocrit, an increase in the amount of fibrinogen and ESR can be observed. Special examination methods allow you to clarify the depth of changes in the rheological properties of the blood - for this, a coagulogram, bleeding time according to Duke and clotting time according to Burker are used. Here, changes in the form of an increase in prothrombin time and prothrombin index can be observed, and the clotting time according to Burker decreases. A special indicator - D-dimer - allows you to confirm the presence of blood thickening and is the most important of all indicators.

Instrumental diagnostics of thrombophlebitis during pregnancy implies the earliest possible confirmation of the diagnosis, as well as monitoring of the fetus's condition. For this purpose, an ultrasound is necessarily performed to determine the fetus's condition, and in the later stages of pregnancy - cardiotocography, which allows determining the fetal heartbeat and uterine tone.

Special instrumental methods for diagnosing thrombophlebitis during pregnancy are Dopplerography of vessels with ultrasound duplex scanning. This method allows you to determine the condition of the affected vein and blood circulation in it. The method is based on the reflection of an ultrasound signal from moving objects of blood - formed elements, which allows you to get an image. Phlebography can also be performed, but this method is invasive and is not recommended during pregnancy.

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Differential diagnosis

Differential diagnostics of thrombophlebitis during pregnancy should be carried out depending on the localization of the process. In case of suspected thrombophlebitis of the veins of the small pelvis, it is necessary to exclude other septic postpartum conditions, amniotic fluid embolism, hemorrhoids and other conditions.

In case of localization of the process on the veins of the lower extremities, it is necessary to exclude phlebothrombosis, acute arterial insufficiency, acute thrombosis of the deep veins of the lower extremities. These pathologies have similar symptoms, but an instrumental ultrasound examination of the veins of the extremities allows an accurate diagnosis.

Thrombophlebitis of veins localized in the groin must be differentiated from a hernia. In the case of an inguinal hernia, the cough impulse symptom is positive, and there are no local signs of inflammation, whereas in inguinal thrombophlebitis there is pain, hyperemia and local hyperthermia in the groin. It is very important to establish a diagnosis of thrombophlebitis during pregnancy in time with all research methods, which allows preventing complications for the mother and fetus.

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Treatment thrombophlebitis in pregnancy

Treatment of thrombophlebitis during pregnancy should be aimed not only at eliminating symptoms, but also at preventing complications. Conservative and surgical treatment methods are used. Conservative treatment methods consist of using medications in the acute period and folk and homeopathic treatment in the period of remission.

It is also important to adhere to basic measures that prevent the development of complications in thrombophlebitis.

The regime should be bed rest with legs elevated. It is necessary to bandage the lower extremities with elastic bandages or wear special stockings that help stabilize thrombophlebitis.

Drug treatment of thrombophlebitis has some special features during pregnancy. Given the aseptic inflammation process in the vein wall, antibiotics are not recommended. Indirect anticoagulants are also contraindicated during pregnancy. Therefore, the main groups of drugs in this case are:

1. phlebotonics are drugs that are tropic to the walls of veins and have a relaxing effect on blood vessels;
2. anti-inflammatory agents and agents that prevent coagulation of formed elements;
3. heparin and direct anticoagulants;
4. antihistamines;
5. thrombolytics.

The main drugs used for local therapy are phlebotonics. They cause the least harm, so they are widely used during pregnancy.

Phlebodia or Detralex is a drug that is an excellent venotonic. The mechanism of action of the drug is to activate the tone of the smooth muscles of the vein wall, improve its elasticity and increase functional activity during blood flow. The active substance of the drug reduces the extensibility of the muscular layer of the vessel wall, prevents blood stasis and improves blood rheology. The drug acts on the inner wall of the vein by stabilizing it, which helps to reduce the aggregation of platelets to the endothelium of the vein. This effect reduces the production of inflammatory mediators and prevents damage to the vein valves.

The drug is available in tablet form and is used in a dosage of one tablet twice a day during meals. Contraindications to taking the drug are individual intolerance to the active substance. During pregnancy, the drug is used in the third trimester. The course of treatment depends on individual characteristics, but on average lasts about three months. Side effects of the drug are possible in the form of dyspeptic manifestations and neurovegetative reactions in the form of sweating, tachycardia, increased emotionality.

Of the anti-inflammatory drugs, sodium diclofenac and aspirin are used - but use during pregnancy has a high risk, so the question of using these drugs is decided by the doctor on an individual basis.

Sodium diclofenac is a drug from the group of non-steroidal anti-inflammatory drugs, which has a pronounced anti-inflammatory property, analgesic and inhibits the release of inflammatory mediators. In case of thrombophlebitis, the drug does not allow the process to spread and maintains an aseptic state and reduces the degree of damage to the venous wall. The drug has various pharmacological forms of release in the form of capsules, tablets, suppositories and ointments. Side effects of the drug are its pronounced effect on the gastric mucosa with increased acidity and stimulation of ulcer formation. The drug may affect the nervous system in the form of asthenoneurotic syndrome, as well as affect the bone marrow. Contraindications to the use of the drug are gastric ulcer or hyperacid gastritis, bronchial asthma, allergic reactions in the past to the drug, liver and kidney diseases that can affect its processing. During pregnancy, oral forms of the drug in the third trimester are prohibited, in this case, local treatment with ointments is possible only with the permission of a doctor. The ointment should be applied to the affected veins twice a day in a small amount, do not leave the ointment on overnight, it is better to wipe the skin before going to bed.

Aescusan is a natural herbal medicine for the treatment and prevention of thrombophlebitis. The drug contains natural horse chestnut tincture and vitamin thiamine. Due to this, the drug has a venotonic effect, and it also relieves swelling, improves lymph flow and blood flow in the capillaries and relieves inflammation by stabilizing the vessel wall. By stimulating the production of prostaglandins, Aescusan protects the vascular endothelium from peroxidation. The drug is available in the form of drops. Take ten drops three times a day, can be dissolved in water or washed down with water. Contraindications for the use of the drug are hypersensitivity to the drug or its components, as well as the first trimester of pregnancy. During pregnancy, it is recommended only in the second and third trimesters. Side effects are possible in the form of dyspeptic phenomena, a feeling of a rush of heat, sweating, allergic reactions.

Surgical treatment of thrombophlebitis during pregnancy is usually not used on a planned basis. Surgical intervention is performed in special cases when there is a risk of serious complications. One of such complications may be a floating thrombus, which has an ascending nature of movement and is localized in a small or large saphenous vein. In this case, it is mechanically easy to perform an operation to remove this thrombus - thrombectomy. The operation is performed under local anesthesia with a special position of the lower limbs - they are slightly lowered. In this case, an incision is made below near the ankle and above, after which the saphenous vein is removed. An important stage is the postoperative period, when it is necessary to adhere to bed rest with subsequent tight bandaging of the lower limbs.

If we are talking about postpartum pelvic vein thrombosis, then immediate surgical intervention is a mandatory treatment method, since this condition threatens serious complications. A lower laparotomy is performed with revision of the pelvic cavity, and the scope of surgical intervention is decided intraoperatively depending on the affected area and the degree of local changes.

Traditional treatment of thrombophlebitis during pregnancy

Traditional methods of treating colitis are widely used by expectant mothers due to the minimal harm to the child. There are many treatment methods using both herbs and traditional and homeopathic preparations. The main effect of such treatment is to improve the tone of the veins of the lower extremities and improve the rheological properties of the blood. For better local action, various compresses are widely used:

1. Honey, as a natural source of nutrients and microelements that increase local immunity, has a pronounced tonic effect on blood vessels and stimulates regeneration, is widely used to treat thrombophlebitis. To create a medicine from honey, you need to make a solution of three tablespoons of honey and five drops of linseed oil, then apply this solution to gauze and apply it overnight as a compress to the affected area of the lower limb.
2. White cabbage improves blood flow through the veins, thereby reducing blood stasis by relieving local edema. Cabbage is also used to make compresses - for this, you need to wash one cabbage leaf with warm water, lubricate it with oil and place it on the vein overnight, then bandage it.
3. Wormwood compresses are also widely used in this case. To do this, brew an infusion of wormwood and boiled water, then after settling, dilute it in an equal amount of sour cream and lubricate the affected veins. This should be repeated three times a day, making compresses for thirty minutes.
4. You need to make a special remedy from three tablespoons of honey, ten drops of aloe, five drops of sea buckthorn oil and a few drops of carrot juice. Mix this and make compresses for two to three hours once a day.

Herbal infusions are widely used:

1. Horse chestnut tincture can be bought at a pharmacy or prepared by yourself. To do this, take ten chestnuts, peel them and pour alcohol over the shell. Infuse for at least a week, before use you can dilute it with boiled water in a ratio of one to one, and then take two tablespoons three times a day before meals.
2. An infusion of nettle leaves, which is prepared according to the standard scheme, should be taken one teaspoon twice a day before meals.
3. Three medium apples should be cut into pieces, poured with a liter of water and boiled for half an hour, then left for another hour, strained and this compote taken in a glass three times a day.

Homeopathic remedies can not only increase the tone of the vein wall, but they also improve the rheological properties of the blood. The main drugs are:

1. Venoflegel is a homeopathic combination remedy from the phlebotonics group. The drug activates the tone of the smooth muscles of the vein wall, reduces its elasticity and extensibility, increasing its functional activity during blood flow. The active substance of the drug prevents blood stasis and improves blood rheology. It is produced in the form of an ointment and is applied twice a day to the affected areas of the lower extremities. The drug has no contraindications. No side effects have been found.
2. Edas 203 is a homeopathic preparation that affects the vein wall locally by increasing the tone of the venous wall and activating the processes of reparation of the venous endothelium. The preparation is available in the form of an ointment and is used three times a day by smearing the affected areas. Contraindication for use is allergic hypersensitivity to the components of the preparation. No side effects were found.
3. Iov venum is a homeopathic combination remedy from the group of systemic phlebotonics. The drug mainly affects platelets, reducing their adhesion, and also normalizes blood flow in the veins. The drug is available in the form of homeopathic granules and is taken two granules half an hour before meals, they should not be washed down with water, but simply dissolved. The drug has no contraindications. Side effects are rare, but nausea and allergic skin reactions may occur.

These are the main folk methods of treatment that help normalize vascular tone and rheological properties of blood in case of their long-term use. Considering their harmlessness to the fetus, such methods of treatment can be used by women from the risk group.

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Prevention

Disease prevention measures can only be non-specific. First of all, women who suffer from varicose veins of the lower extremities need to take preventive measures:

• you need to wear special knitted tights or stockings according to the degree of compression required or bandage with elastic bandages;
• Avoid wearing tight shoes and clothing to avoid compression;
• there should be sufficient physical activity, but without strength training. You need to walk in the fresh air for at least two hours every day;
• It is necessary to maintain sufficient water intake – avoid swelling, but also do not allow dehydration;
• You cannot use any medications without consulting a doctor, as this may harm the child;
• It is best to take preventive measures against the disease several months before planning a pregnancy.

Such simple preventive measures will help avoid complications during pregnancy.

Thrombophlebitis during pregnancy threatens many complications, so it is important to know the symptoms of this disease and in case of such clinical manifestations, consult a doctor. Treatment of this pathology is selected individually and is used only in the acute period of the disease. In a state of remission, folk remedies and homeopathic preparations are recommended. You need to monitor your health and it is better to treat all diseases before pregnancy.

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