Definition

Every pregnant mother aims to stay healthy during pregnancy. However, bodily changes that occur during pregnancy can lead to health issues and discomfort. One such health issue that can arise during pregnancy is thrombophlebitis, an inflammation of the veins. This inflammation can trigger blood clots (thrombosis) in one or more veins.

Thrombophlebitis can occur in veins near the skin's surface (superficial thrombophlebitis) or deep within the muscles (deep vein thrombosis, or DVT). Thrombophlebitis most often occurs in the legs but can also affect the arms.

Pregnancy is one of the risk factors for thrombophlebitis. In addition to pregnancy, women remain at risk of thrombosis during the postpartum period, up to three months after giving birth. The incidence rate of superficial thrombophlebitis in postpartum women is 1.18%, while the rate for DVT is 0.15%.

This health issue can disrupt a mother's daily activities because the affected area may become swollen and painful. Blood clots that dislodge can also block pulmonary blood vessels (pulmonary embolism) and pose a life-threatening risk. Therefore, thrombophlebitis during pregnancy should be treated promptly to avoid complications that could negatively impact pregnancy or childbirth.

However, treating thrombophlebitis in pregnant women requires special attention since some medications commonly used for thrombophlebitis may have side effects on pregnancy.

Though pregnant women are at a higher risk of developing thrombophlebitis, the condition is still relatively rare, with approximately 1-2 cases per 1,000 pregnancies.

Causes

Several factors increase the risk of blood clotting in pregnant women:

• During pregnancy, blood clotting helps reduce bleeding.
• Pregnant women experience reduced blood flow to the legs because veins around the pelvis that supply the legs are compressed by the enlarging uterus.

Additionally, there is an increase in most clotting factors and a decrease in fibrinolytic activity (the breakdown of blood clots). Clotting factor levels gradually rise after the third month of pregnancy, doubling compared to when not pregnant. During the second half of pregnancy, levels of clotting factors VII, VIII, IX, and X, which play roles in blood clotting, also increase.

Along with reduced fibrinolytic activity, there is also a decrease in protein S activity, which is involved in blood clotting, by about 68% during pregnancy and postpartum. Protein S levels return to normal 12 weeks after delivery. All these blood clotting changes are necessary to prevent excessive bleeding during and after childbirth.

Another risk factor for thrombophlebitis is significant weight gain during pregnancy. This can lead to restricted blood flow in the veins, triggering inflammation.

In addition to weight gain, another factor that can cause vein inflammation in pregnant women is lack of movement. Pregnant women tend to be less physically active or rarely exercise during pregnancy, making them more susceptible to thrombophlebitis.

For instance, if a pregnant woman sits for too long or doesn’t move her legs for an extended period, the calf muscles won’t contract to help circulate blood, increasing the risk of larger blood clots.

Risk Factor

Risk factors for thrombophlebitis in pregnant and postpartum women include:

• A family history of blood clotting disorders
• Age over 35
• Obesity
• Smoking and alcohol consumption
• Dehydration
• Twin pregnancy
• Cesarean delivery
• Inactivity, such as bed rest or postpartum recovery
• Long-term illnesses like heart disease, lung disease, or diabetes
• Use of contraceptives or hormonal agents before pregnancy
• Injury to veins, such as from pacemaker or catheter placement
• Recent severe injury, like bone fractures

Symptoms

Symptoms of thrombophlebitis in pregnant and postpartum women include:

• Swelling in the affected area
• Pain
• Warmth upon touch
• Hardened skin over the affected area
• Red or darker skin color
• Increased pain when pressure is applied to the inflamed area

Diagnosis

Diagnosis is made through symptom evaluation, physical examination, and further tests such as laboratory tests and ultrasound of the affected area. If lab tests and ultrasound are inconclusive, contrast MRI can be used to detect blood clots.

Management

The goal of thrombophlebitis treatment in pregnant women is to relieve symptoms and prevent complications. Doctors typically prescribe medications to treat thrombophlebitis in pregnant women.

However, considering certain blood thinners are not recommended during pregnancy, medications such as anti-inflammatory drugs, heparin, antihistamines, or thrombolytics may be used.

In addition to medication, pregnant women are advised to:

• Apply warm compresses to the affected area
• Rest with the legs elevated to promote blood circulation
• Stay active
• Wear compression stockings

Complications

Thrombophlebitis complications in pregnant women include:

• Discomfort during daily activities
• Blood clots may dislodge and travel to other parts of the body, potentially causing issues in those areas. If a clot blocks a deep vein, it can result in deep vein thrombosis (DVT). If it blocks a pulmonary artery, it can cause life-threatening pulmonary embolism.

Prevention

Since the risk of thrombophlebitis is higher during pregnancy, regular health check-ups are crucial to detect any health issues, including thrombophlebitis, early.

Other preventive measures include changing positions every hour if sitting or standing for long periods. When you are travelling, take breaks to walk around every hour. If flying, riding a train, or on a bus, walk down the aisle every hour. If driving, stop every hour or so, stand up, and move your legs.

Pregnant women with thrombophlebitis need prompt treatment. Always consult your doctor about which medications are safe for you to prevent worsening symptoms, complications, and harmful side effects during pregnancy.

When DVT is diagnosed and treated, the risk of pulmonary embolism decreases.

When to See a Doctor?

If you are pregnant or postpartum and experience symptoms of thrombophlebitis as described above, consult a doctor immediately for proper diagnosis and treatment.

Call emergency services or take the mother to the emergency room if experiencing:

• Shortness of breath or difficulty breathing
• Chest or upper back pain or pressure
• Coughing up blood

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