Thrombophlebitis in Pregnancy

Thrombophlebitis in pregnancy is a frequent pathology in women with a burdened background of thrombophlebitis, and in women who first encounter this problem. This is explained by physiological changes in the body of a woman during pregnancy, features 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 correct the rheological properties of blood in time in the case of this pathology before pregnancy and treat this disease during pregnancy.

Causes of the thrombophlebitis in pregnancy

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

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

The risk factors for the formation of thrombophlebitis during pregnancy include:

1. excessive body weight, which worsens the outflow of blood through the veins because of the anatomical features of the location of venous vessels;
2. insufficient motor activity, as well as a sedentary mode of work - this reduces the tone of the veins and worsens the outflow of blood along them with the formation of edema;
3. diseases of the cardiovascular system, which are accompanied by worsening of the pumping function of the heart and the formation of edema, which contributes to a mechanical obstruction for outflow of blood;
4. complications of pregnancy in the form of early gestosis;
5. reception of contraceptives or other hormonal agents on the eve of pregnancy.

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

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

[1], [2], [3], [4], [5], [6], [7]

Pathogenesis

To find out the pathogenesis of thrombophlebitis during pregnancy, it is necessary to disassemble some features of this process. It is necessary to clearly distinguish two basic concepts - thrombophlebitis and phlebothrombosis. Phlebotrombosis is the formation of a thrombus in the vein wall, which is intact, that is, without the accompanying inflammatory process in it. Thrombophlebitis is a disease of the veins of the great circle of 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 wall of the vein in the form of trauma to the inner shell and a violation of its integrity. This is accompanied by a violation of local blood flow in this place due to the fact that there is a vortex of blood flow. The pregnant woman has more dense blood, which contributes to an even more marked stasis of blood in this place, and the increased amount of clotting factors in the blood of a pregnant woman contributes to the fact that there are all conditions for the formation of a thrombus. In this case, there are all conditions for stasis of blood, formation of a thrombus, and the presence of any infectious process in the body induces the whole complex of reactions for the formation of thrombophlebitis. If a woman before birth suffered from the pathology of the venous system in the form of varicose veins of the lower limbs, such violations of anatomical features further contribute to the formation of thrombophlebitis. Frequently, thrombophlebitis is formed in the early postpartum period and this is considered a postpartum septic state.

By localization, which is most often found in pregnancy, distinguish thrombophlebitis of deep and superficial veins - respectively, thrombophlebitis of the veins of the pelvis and lower limbs.

Given these features, it must be said that women with a history of the disease are at risk, and this requires preventive measures before pregnancy.

[8], [9], [10]

Symptoms of the thrombophlebitis in pregnancy

Thrombophlebitis in 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 veins of the small pelvis is more common.

The first signs of thrombophlebitis in pregnancy can appear in later periods, when the changes are expressed as much as possible, which is explained by an increase in the body weight of the pregnant woman, and a decrease in motor activity, and rheological changes in blood.

Thrombophlebitis of the veins of the lower extremities has a lighter course, since the localization of the process makes it possible to diagnose the diseases in time. In this case, the symptoms of this disease are as follows: there is hyperemia of the inflamed vein, a local increase in the temperature of the skin over it, local soreness and swelling of the soft tissues along the vein. With local palpation of the affected vein, pain increases. These symptoms are further accompanied by systemic manifestations of the inflammatory process in the form of an intoxication syndrome - the body temperature can rise, there is headache and pain along the entire leg, working capacity decreases and the general condition worsens. If women have concomitant varicose veins of the lower extremities, then such veins will be enlarged, 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 by similar symptoms - pain, local hyperemia, hyperthermia, swelling of the tissue. In this case, because of the localization of this process, differential diagnostics with inguinal hernia is necessary.

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 veins of the pelvis is more frequent in the early postpartum period, especially in women with caesarean section. In this case, a woman feels a sharp pain in the abdomen or pelvis, the manifestations of intoxication syndrome - body temperature, nausea, vomiting, headache increase. When performing an examination, sometimes in case of close localization of the venous node it is possible to palpate the painful compaction. This allows you to suspect thrombophlebitis and requires immediate action.

These are the main symptoms of thrombophlebitis in pregnancy, which allow you to suspect pathology and take urgent measures.

Complications and consequences

Complications of thrombophlebitis during pregnancy can be very serious in case of untimely diagnosis or treatment. The consequence of thrombophlebitis of the veins of the lower limbs can be acute venous insufficiency, thromboembolism of the great circle of blood circulation, flotation thrombus, and acute phlebitis. If the process concerns the veins of the pelvis, then the septic process spreads with the threat of thrombosis of the inferior vena cava.

[11], [12], [13], [14], [15], [16], [17]

Diagnostics of the thrombophlebitis in pregnancy

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

Diagnosis should begin with a careful collection of anamnestic data. At the same time, it is necessary to detail the complaints and clarify when the disease first started, how the symptoms developed, and whether there were systemic changes. It is also necessary to find out whether there is a woman with a varicose veins of the lower extremities. Then you need to examine the legs and determine the condition of superficial veins and the presence of edema.

Analyzes are an important indicator for the diagnosis of thrombophlebitis in pregnancy, as well as for monitoring the basic indicators of the state of a pregnant woman. Conduct general tests and special - a general blood test with the determination of platelets, a general urine test, feces, a biochemical blood test. There may be changes in the form of an increase in hematocrit, an increase in the amount of fibrinogen and ESR. Special methods of examination make it possible to clarify the depth of changes in the rheological properties of the blood - for this use the coagulogram, the Duke bleeding time and the Burker clotting time. Here, changes can occur in the form of an increase in prothrombin time and a prothrombin index, as well as a decrease in the Burker clotting time. A special indicator - D-dimer - confirms the presence of blood clots and is the most important of all indicators.

Instrumental diagnosis of thrombophlebitis in pregnancy means as early as possible confirmation of the diagnosis, as well as control of the fetus. For this, ultrasound is usually performed with the determination of the fetal condition, and in the late stages of pregnancy - cardiotocography, which allows to determine the state of the fetal heartbeat and the tone of the uterus.

Special instrumental methods for diagnosis of thrombophlebitis in pregnancy are dopplerography of vessels with ultrasonic duplex scanning. This method allows you to determine the condition of the affected vein and the blood circulation in it. A method based on the reflection of an ultrasonic signal from movable objects of blood - shaped elements, which makes it possible to obtain an image. You can also conduct phlebography, but this method is invasive and is not recommended in pregnancy.

[18], [19], [20], [21]

Differential diagnosis

Differential diagnosis of thrombophlebitis in pregnancy should be carried out depending on the localization of the process. In case of suspicion of thrombophlebitis of the pelvic veins, other septic postpartum conditions, embolism with amniotic fluid, hemorrhoids and other conditions should be excluded.

In the case of localization of the process in the veins of the lower limbs, phlebothrombosis, acute arterial insufficiency, acute thrombosis of the deep veins of the lower extremities should be excluded. These pathologies have similar symptoms, but it is possible to establish the diagnosis by instrumental ultrasound examination of limb veins.

Thrombophlebitis of veins localized in the groin must be differentiated from a hernia. In the case of inguinal hernia is a positive symptom of coughing, and there are no local signs of inflammation, whereas with inguinal thrombophlebitis there is soreness, hyperemia and local hyperthermia in the groin. It is very important to establish a diagnosis of thrombophlebitis in pregnancy with the carrying out of all methods of research, which helps to prevent complications for the mother and for the fetus.

[22], [23], [24]

Treatment of the thrombophlebitis in pregnancy

Treatment of thrombophlebitis in pregnancy should be directed not only at the elimination of symptoms, but also at preventing complications. Use conservative methods of treatment and operative. Conservative methods of treatment consist in the use of medicines in the acute period and alternative and homeopathic treatment in the period of remission.

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

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

Drug treatment of thrombophlebitis provides some features during pregnancy. Considering the aseptic process of inflammation in the vein wall, the use of antibiotics is not recommended. Also during pregnancy, it is contraindicated to use indirect anticoagulants. Therefore, the main groups of drugs in this case are:

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

The main drugs that are used as a local therapy are phlebotonics. They bring the least damage, so they are widely used in pregnancy.

Flebodia or Detralex is a drug that is an excellent acting 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 the 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 reduce the aggregation of platelets to the endothelium of the vein. This effect reduces the production of mediators of inflammation and prevents damage to the veins valves.

The drug is available in the form of tablets and is used in dosage - one tablet twice a day during meals. Contraindications to taking the drug is an individual intolerance of the active substance. During pregnancy, the drug is used in the third trimester. The course of treatment depends on individual characteristics, but on average it 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 anti-inflammatory drugs use diclofenac sodium, aspirin - but use during pregnancy has a high risk, so the question of the use of these drugs is decided by the doctor in an individual case.

Diclofenac sodium 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 the case of thrombophlebitis, the preparation does not make it possible to spread the process and maintains the aseptic state and reduces the degree of venous wall damage. The preparation has various pharmacological forms of release in the form of capsules, tablets, suppositories and ointments. Side effects of the drug - is its pronounced effect on the gastric mucosa with increased acidity and stimulation of ulceration. Perhaps the effect of the drug on the nervous system in the form of asthenoneurotic syndrome, as well as the effect on the bone marrow. Contraindications to the use of the drug - a stomach ulcer or hyperacid gastritis, bronchial asthma, allergic manifestations in the past on the drug, liver and kidney disease, which may affect its processing. In pregnancy, oral forms of the drug in the third trimester are prohibited, in this case, local treatment with ointments is allowed only with the permission of the doctor. Ointment should be applied to the affected veins twice a day in small amounts, do not leave the ointment at night, it is better to wipe the skin before going to bed.

Escuzane is a natural herbal medicament for treating and preventing thrombophlebitis. The preparation includes natural tincture of horse chestnut and vitamin thiamine. Due to this the preparation has a venotonic effect, as well as it removes edema, improves the lymph drainage and blood flow in the capillaries and relieves inflammation due to the stabilization of the vessel wall. Due to the stimulation of prostaglandin production, Escuzane protects the vascular endothelium from peroxidation. The drug is available in the form of drops. Take it on ten drops three times a day, can be dissolved in water or washed down with water. Contraindications for the use of the drug - is hypersensitivity to the drug or its components, as well as the first trimester of pregnancy. When pregnancy is recommended only in the second and third trimester. Side effects are possible in the form of dyspeptic phenomena, sensation of hot flushes, sweating, allergic reactions.

Operative treatment of thrombophlebitis during pregnancy in a planned manner, as a rule, do not use. Surgical intervention is performed in special cases when there is a risk of serious complications. One of such complications can be a floating thrombus, which has an ascending character of movement and is localized in a small or large saphenous vein. It is mechanically simple to perform the operation in the volume of removal of this thrombus - thrombectomy. The operation is performed under local anesthesia with a special position of the lower extremities - they are slightly lowered. In this case, a cut is made at the bottom near the ankle and at the top, after which the subcutaneous 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 extremities.

If we are talking about postpartum thrombosis of pelvic veins, then an immediate method of treatment is immediate surgical intervention, since this condition is threatening with serious complications. The lower laparotomy is performed with revision of the pelvic cavity, and the volume of the operative intervention is solved intraoperatively depending on the site of the lesion and the degree of local changes.

Alternative treatment of thrombophlebitis in pregnancy

Alternative methods of treating colitis are widely used by future mothers because of minimal harm to the child. There are many treatments with the use of both herbs and alternative remedies and homeopathic medicines. The main effect of this treatment is an improvement in the tone of the veins of the lower limbs and an improvement in the rheological properties of the blood. For a better local action, various compresses are widely used:

1. Honey, as a natural source of nutrients and trace elements that increase local immunity, has a pronounced tonic effect on the 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, after which such a solution is applied to the gauze and put on the night as a compress on the affected area of the lower limb.
2. Cabbage improves the flow of blood through the veins, which reduces the stasis of blood by removing the local edema. From the cabbage, compresses are also made-for this you need to wash one leaf of cabbage with warm water, oil it and put it on the vein site for the night, then bandage.
3. Wormwood compresses are also widely used in this case. To do this, brew infusion of wormwood and boiled water, then after settling it should be diluted in an equal amount of sour cream and lubricate the affected veins. So it is necessary to repeat three times a day, making compresses for thirty minutes.
4. You need to make a special tool of three tablespoons of honey, ten drops of aloe, five drops of sea buckthorn oil and a few drops of carrot juice. This is to mix and make compresses for two to three hours once a day.

Widely used infusions of herbs:

1. Tincture of horse chestnut can be bought at the pharmacy or cooked yourself. To do this, you need to take ten chestnuts, clean them and add alcohol to this shell. Infuse for at least a week, before use, you can dilute boiled water in a ratio of one to one, and then take three times a day for two tablespoons before meals.
2. Infusion of leaves of nettle, which is prepared according to the standard scheme should be taken on a teaspoon twice a day before meals.
3. Three average apples should be cut into pieces, pour a liter of water and cook for half an hour, then insist another hour, strain and take such a compote on a glass three times a day.

Homeopathic remedies can not only improve the tone of the vein wall, but they also improve the rheological properties of the blood. The basic preparations:

1. Venoflegel is a homeopathic combined remedy from the group of phlebotonics. 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 released in the form of an ointment and applied twice a day to the affected areas of the lower extremities. Does not have a contraindication. No side effects were detected.
2. Edas 203 is a homeopathic preparation that affects locally on the vein wall by increasing the tone of the venous wall and activating the processes of vein endothelial repair. The drug is available in the form of an ointment and is used three times a day by spreading the affected areas. Contraindications for use - allergic hypersensitivity to the components of the drug. No side effects were detected.
3. Job Venum is a homeopathic combined remedy from the group of phlebotonics of systemic action. The drug mainly acts on platelets, reducing their adhesion, and also normalizes the flow of blood in the veins. The drug is produced 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 dissolve. Does not have a contraindication. Side effects are rare, but there may be nausea and allergic skin reactions.

These are the main alternative treatments that contribute to the normalization of the vascular tone and rheological properties of the blood in the case of their long-term use. Given their harmlessness to the fetus, such methods of treatment can be used for women at risk.

[25]

Prevention

Measures to prevent disease can only be nonspecific. First of all, women who suffer from varicose veins of the lower extremities should take preventive measures:

•  It is necessary to wear special knitted tights or stockings according to the degree of necessary compression or to make bandages with elastic bandages;
•  Do not allow tight shoes and clothing to avoid compression;
•  must be sufficient motor mode, but without power loads. You must walk in the open air for at least two hours every day;
•  it is necessary to observe a sufficient water regime - to avoid edema, but not to allow dehydration;
•  Do not use any medication without consulting a doctor, as this can harm the child;
•  It is best to prevent the disease several months before the pregnancy is planned.

Such simple preventive measures will avoid complications during pregnancy.

Thrombophlebitis during pregnancy is threatened with many complications, so it is important to know about the symptoms of this disease and in case of similar clinical manifestations to consult a doctor. Treatment of this pathology is selected individually and is used only in the acute period of the disease. In remission, alternative remedies and homeopathic remedies are recommended. It is necessary to monitor your health and better treat all diseases before pregnancy.

[26], [27], [28], [29],