The American College of Obstetricians and Gynecologists recently issued a new recommendation recently, following evidence that having a c-section nearly doubles the risk of deep vein thrombosis (DVT) or thromboembolism which result in blood clots and can be fatal. The recommendation is that women undergoing a c-section should have inflatable compression devices on their legs as a preventative measure to clots forming.
The potential for thromboembolism is common to all pregnant women and it’s potential is four times than women who are not pregnant due to slower blood flow and restrictions in the pelvis and legs. When pregnant women have blood clots they are usually VTE (venous thromboembolism), which mostly form within the deep veins of the leg. In the USA between 1991–1997 thrombotic embolism accounted for 327 of the 3201 maternal deaths.
In worst case scenarios a blood clot cuts of blood supply to a major organ and can prove fatal. Exacerbating factors for this condition are smoking, high blood pressure, smoking (hypertension) and obesity For women who fall into one of these, or other form of higher risk group such as those with a history of clotting, the ACOG advised they additionally receive anticoagulant (anti-clotting) medications, in addition to the inflatable compression devices.
The common symptoms of DVT are pain or swelling of the leg (more often the left leg). Other symptoms consist of tenderness, increased temperature, lower abdominal pain or a raised white cell count.
Blood clots could also dislodge and be carried to the lungs causing a pulmonary embolism ( PE ), also potentially fatal, though rarely causing sudden death without warning. Symptoms of this condition include faintness, sudden shortness of breath, coughing, chest pain, raised jugular venous pulse and signs or symptoms of DVT.
In a college news release Dr. Andra H. James, who helped develop the new guidelines, said,
“VTE [venous thromboembolism] is a major contributor to maternal mortality in this country. The risk of VTE is increased during pregnancy and the consequences can be severe.” She then added, “It’s important for ob-gyns to adopt these recommendations to help reduce maternal deaths.”
Dr James explained, “Fitting inflatable compression devices on a woman’s legs before cesarean delivery is a safe, potentially cost-effective preventive intervention…. Inflatable compression sleeves should be left in place until a woman is able to walk after delivery or—in women who had been on blood thinners during pregnancy—until anticoagulation medication is resumed.”
However, the authors of the report say delaying delivery in emergency C-sections for placement of the devices is inadvisable.
The authors also cautioned that all women who have undergone C-sections also need to be monitored for the development of VTE post delivery. James said,
“Because half of VTE-related maternal deaths occur during pregnancy and the rest during the postpartum period, ongoing patient assessment is imperative. While warning signs in some women may be evident early in pregnancy, others will develop symptoms that manifest later in pregnancy or after the baby is born.”