Thrombolysis complications after childbirth

Surface thrombophlebitis

Acute thrombophlebitis is a frequent complication after childbirth, manifested by pain along the course of the affected vein. Complaints - the local sensation of heat, redness and tenderness along the subcutaneous vein. Vienna is palpable in the form of a dense painful cord, hyperemia can spread beyond the boundaries of the veins, possible infiltration of adjacent tissues, lymphadenitis. The general condition of the puerpera is little disturbed, subfebrile body temperature, tachycardia are determined.

Deep vein thrombophlebitis

Complaints of this complication after childbirth are as follows: patients feel a bursting pain on the side of the lesion, swelling of the affected limb and a change in the color of the skin. Objective manifestations that correspond to the stage of compensation: an increase in body temperature (often the first and only sign of venous thrombosis), there are no pronounced violations of venous hemodynamics. Objective manifestations that correspond to the stage of decompensation: intense pain, which often changes its localization; feeling of heaviness and tension; edema, which seizes the entire limb, impaired lymphatic drainage, regional lymph nodes increase; the change in skin color from pale to saturated cyanotic, diffuse cyanosis of the entire limb predominates.

Diagnosis is based on clinical and laboratory data:

• assessment of the degree of embolus hazard - determination of the level of D-dimer in plasma (D-dimer-test);
• thromboelastogram, coagulogram;
• determination of the amount of fibrin-monomer in blood serum (FM-test, monotest-FM);
• determination of degradation products of fibrin and fibrinogen in plasma (FDP PLASMA).

Apply instrumental methods, duplex ultrasonic angioscanning with color Doppler mapping; radionuclide study with labeled fibrinogen; radiocontrast retrograde ileocavagraphy.

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Septic thrombophlebitis of pelvic veins

With endomyometritis, the infectious agent enters the venous bloodstream, affects the endothelium of blood vessels and promotes the formation of thrombi, mainly anaerobic infection prevails. The veins of the ovary are involved in the process, thrombi can penetrate into the inferior vena cava, the renal vein. Complaints - pain in the lower abdomen with irradiation in the back, groin, nausea, vomiting, bloating, fever are possible. When a vaginal examination is palpated, a thickening in the form of a rope in the region of the corners of the uterus. With septic thrombophlebitis, there may be migration of small thrombi into the small circulation.

Treatment of thrombotic complications after childbirth

Treatment of thrombotic complications in the postpartum period, along with antibiotics and detoxification should include:

• bed rest with placement of the lower limb on the bus of Belera until the disappearance of pronounced edema and the appointment of anticoagulant therapy; 
  • local hypothermia along the projection of the thrombosed vascular bundle;
  • elastic compression with the use of elastic bandages;
  • correction of the act of defecation with the use of laxatives (stress warning);
• drug therapy; 
  • anticoagulants during the exacerbation of the disease. Direct anticoagulants - heparin, low molecular weight heparins (Fraxiparin, Pentoxane, Clexane, Fragmin, etc.) with the transition to indirect anticoagulants;
  • indirect anticoagulants are prescribed 2 days before the cancellation of direct anticoagulants for 3-6 months;
  • hemorheological active agents - pentoxifylline, reopolyglucin - followed by a transition to antiplatelet therapy - aspirin, plavix up to 1 year;
  • remedies that improve phlebohemodynamics - phlebodia, detralex, escusin for 4-6 weeks;
  • systemic enzyme therapy - vobenzim, flobenzim, biosin;
• local treatment of complications after childbirth, which is performed from 1 day of the disease: 
  • local hypothermia;
  • application of ointments based on heparin (heparin, troxevasin, lyoton 1000) or non-steroidal anti-inflammatory drugs (fastum-gel, diclofenac-gel).