One winter morning, the maternity ward was as busy as usual. The 36-year-old newly recruited “Er Bao Mom” Lele received a cesarean section the day before and gave birth to a lovely “Er Bao”. The whole family was happy to have flowers. .
During pregnancy, Lele was found to be suffering from gestational diabetes and dyslipidemia, and her legs were a little swollen, but she didn’t take it seriously. At this time, Lele felt extremely happy looking at the baby who was born smoothly. Unexpectedly, the attending doctor hurriedly came over and said: “LeLe, your coagulation index D-dimer is very high. You need to do CT angiography immediately to rule out venous thromboembolism.” Lele was stunned and full. Belly question: What is D-dimer? What is venous thromboembolism? I’m not obviously uncomfortable? However, looking at the doctor’s serious expression, she didn’t care about asking so many questions, so she hurriedly went for a checkup. Sure enough, the examination result indicated “thrombosis in the tertiary branch of the left upper pulmonary artery.” The attending doctor told Lele: “Pulmonary embolism is very dangerous and may be life-threatening in severe cases. Don’t do strenuous activities now, we will give you low-molecular-weight heparin.” Lele is puzzled: What is pulmonary embolism?
This is a typical obstetric pulmonary embolism case. To answer Lele’s questions, we must understand the venous thromboembolism (VTE), the “invisible killer” of pregnant women. VTE includes deep vein thrombosis (the most common deep vein thrombosis of the lower extremities) and pulmonary thromboembolism (a type of pulmonary embolism). The risk of VTE in pregnant women is 5 to 10 times higher than that of ordinary people, and the incidence of pregnancy-related VTE is 0.5‰ to 2.2‰. At present, the harm of VTE during pregnancy and postpartum has exceeded that of postpartum hemorrhage, and it is one of the important causes of maternal death.
Pregnant women, high-risk groups of venous thrombosis
The main causes of venous thrombosis are slow blood flow, hypercoagulable state of blood, and damage to the blood vessel wall. The reason why pregnant women are prone to venous thromboembolism is that there are many high-risk factors during pregnancy and childbirth, such as: increased blood volume after pregnancy; due to the action of progesterone, blood is in a hypercoagulable state and blood viscosity increases; increased uterine compression The abdominal veins cause obstruction of blood return, causing varicose veins in the lower limbs and pelvis, and slow blood flow; etc. At the same time, there are the following unique high-risk factors for pregnant and lying-in women in
China : Old age After the implementation of the comprehensive two-child policy in China, there are more and more advanced-age pregnant and lying-in women. Older pregnancy is an independent risk factor for venous thrombosis, which is closely related to factors such as hypertension, diabetes, and obesity.
Decrease in activity and increase in obesity and other metabolic-related diseases. With the improvement of living conditions, most people have entered the “chronic disease period” from the previous “starvation reduction period”, and the incidence of obesity, hyperglycemia, and dyslipidemia has increased significantly.
The custom of “confinement” During the period of “confinement”, mothers are often restricted in their activities for a long time, mainly “lying down”, which causes the blood flow to slow down. At the same time, some parturients take a lot of high-protein and high-fat foods during the confinement period, resulting in increased blood viscosity and further slowing of blood flow.
Increased application of assisted reproductive technology Pregnant women receiving assisted reproductive technology treatment need to use progesterone at certain stages, which can increase the probability of venous thrombosis.
What are the consequences of venous thrombosis
Deep vein thrombosis is most common in the lower extremities. Common symptoms are swelling, pain, and heaviness in the lower extremities. The local skin temperature may increase, and the color may be normal or purplish red. There are also some patients who have no symptoms of discomfort and are only found during screening, which is easy to miss.
Most of the thrombus that causes pulmonary thromboembolism originates from the deep veins of the lower extremities. The clinical manifestations of pulmonary embolism are diverse, and the symptoms are mainly determined by the amount of blood vessel blockage, the rate of occurrence, and the basic state of the heart and lungs. In mild cases, only a few lung segments are involved, and patients may have no obvious symptoms; in severe cases, most lung segments are affected. Common symptoms include dyspnea, chest pain, panic, cough, hemoptysis, syncope, etc., which can lead to shock or sudden death. Because the symptoms of pulmonary embolism are diverse and non-specific, it is easy to be missed. In addition, some symptoms of pulmonary embolism overlap with the normal physiological changes of pregnancy. For example, the incidence of dyspnea in normal pregnancy is as high as 70%. Therefore, it is extremely challenging to identify clinically significant pulmonary embolism during pregnancy.
Because some patients with venous thromboembolism have no typical clinical manifestations and can only be found through screening, doctors generally first assess the risk of venous thrombosis in pregnant women, and then pass some auxiliary tests, such as coagulation function (D -Dimer, etc.), ultrasound, CT angiography, etc., for further confirmation. This is the case for Lele above. She did not show obvious symptoms of discomfort, but was diagnosed through auxiliary examinations. This is also an important reason why we call venous thromboembolism the “invisible killer”.
To prevent venous thrombosis, it should go through the entire pregnancy and childbirth period
For pregnant women, venous thrombosis should be prevented throughout the pregnancy and childbirth. Good living habits are the key to preventing venous thrombosis. It is necessary to eat a reasonable diet, avoid overweight or obesity, strengthen exercise, control blood sugar and blood lipids, and ensure adequate water intake. In short, you should keep your mouth shut and open your legs after pregnancy. If you cannot exercise effectively for special reasons, you can take passive exercise methods, such as leg massage, wearing elastic stockings, etc.
For pregnant women with a history of venous thrombosis, as well as high-risk factors such as hypercoagulable blood, advanced age, obesity, and long-term bed rest, if there are no obvious contraindications, they need to take drug prevention according to the doctor’s recommendation, such as the use of low-dose low molecular Heparin etc.
What should I do if related symptoms occur
If there are unexplained dyspnea, chest pain, chest tightness, hemoptysis during pregnancy and childbirth, be wary of pulmonary embolism; if there are signs of swelling or pain in the calf or thigh, be wary of deep vein thrombosis in the lower extremities. Once the above symptoms occur, keep calm, reduce activity, avoid massaging the affected limb, and go to the nearest regular hospital immediately. Once the diagnosis is confirmed, the doctor should actively cooperate with the treatment, and the specific treatment plan needs to be determined according to the location and severity of the thrombus. The main treatment methods are anticoagulation, thrombolysis, etc. Timely anticoagulation is the key to successful treatment.
Lele mentioned above, because of the few lung segments involved, was discovered in time and was discharged smoothly after 2 weeks of medication. After that, she continued to use anticoagulant drugs for a period of time, and the follow-up examination report indicated that everything was normal, and the family’s hanging heart was finally let go.
Ying Hao, Deputy Dean, Director of Obstetrics, Chief Physician, Professor, Doctoral Supervisor, First Maternal and Child Health Hospital Affiliated to Tongji University, member of Perinatal Medicine Branch of Chinese Medical Association, and Deputy Chairman of Shanghai Maternal and Child Safety Committee. Good at diagnosis and treatment of miscarriage and premature birth related to cervical dysfunction, abnormal placenta, obstetric endocrine diseases, etc.