More than shortness of breath or leg swelling: Recognizing risks and symptoms of life-threatening blood clots during pregnancy
When I meet with women who have had a blood clot during pregnancy or in the first few months following childbirth, they usually tell me the same thing: “I had no idea this could happen or was something I should be watching out for.”
Pregnant women are at five times greater risk of a life-threatening blood clot than women who are not pregnant. This risk is greatest for a short period even after delivery. Venous thromboembolism (VTE), the medical term describing blood clots that start in the vein, often form in the deep veins of the legs (deep vein thrombosis or DVT) and can break off and travel to the lungs, (pulmonary embolism or PE). PE’s cause nearly 10% of maternal deaths in the Western world.
In very rare cases, a DVT can travel through a previously undiagnosed hole in the heart – a congenital heart defect called a patent foramen ovale – and cause what is known as a paradoxical stroke.
A DVT clot that breaks off can be fatal, but the majority of cases are preventable by managing risk factors, recognizing symptoms and getting immediate treatment.
Why does this happen?
During pregnancy, there is a hyperactivity of the blood-clotting system in the legs. Additionally, the growing baby can obstruct veins in the mother’s pelvis, further slowing blood flow. Other factors that may further heighten this risk include genetic blood-clotting disorders, a history of blood clots, older age at the time of pregnancy, obesity, in vitro fertilization, cesarean delivery and major bleeding after delivery. It is important to note that this increased risk for blood clots persists for about three months after delivery.
Recognizing the symptoms of blood clots is crucial for diagnosis and timely treatment. When I meet with patients, I often ask “Is there anything out of the ordinary that I should know?”
Often, women minimize symptoms, thinking they are part of pregnancy. Mild shortness of breath and rapid heart rate are common in pregnancy, but if the symptoms are severe or come on suddenly, seek immediate medical attention. Similarly, leg swelling often occurs during pregnancy, but if it’s only on one leg – usually the left – it may be a sign you have a DVT.
Symptoms of a PE can include unexplained shortness of breath, rapid breathing, chest pain anywhere under the rib cage that may be worse with deep breathing), fast heart rate, light headedness or passing out. Symptoms of a DVT typically occur on one side and can include leg pain or tenderness of the thigh or calf, leg swelling, skin that feels warm to the touch or has reddish discoloration or red streaks.
Early diagnosis and treatment – which can include blood-thinning medication – may often lead to recovery, but long-term complications may occur. Once you’ve had one blood clot, you’re at increased risk of having others.
World Thrombosis Day is Oct. 13, and the American Heart Association and the International Society of Thrombosis and Hemostasis are encouraging people to understand the risks of blood clots. If you have multiple risk factors, consult with your doctor about how to lower your risks. Learn more about blood clots and how to reduce the risk at heart.org/bloodclotrisk.
Dr. Jorge Antonio Gutierrez, MD, is Assistant Professor of Medicine at Duke University School of Medicine.