In my previous post about DVT in pregnancy I looked at the incidence of clots in Pregnancy. DVT is relatively rare but serious and should not be missed. The Royal College of Obstetricians and Gynaecologists guidelines quote that approximately 20% of DVTs can lead to a pulmonary emboli in pregnancy and these can be rapidly fatal. A suspected case of DVT should be investigated.
The symptoms of a DVT in pregnancy are similar to those to seen in the non-pregnant state, but some features of pregnancy can make them a little harder to identify.
Symptoms of a Deep vein thrombosis
Swollen ankles are very common in pregnancy. In the majority of cases this is not a thing to worry about, but persistent swelling in one leg, or one leg looking bigger than the other can be a feature of a blood clot. This is usually associated with pain often described as cramp like or aching. Again aching legs and cramps are also seen in normal pregnancies.
Discolouration of the skin
A clot in the calf can cause some local redness in the skin and the leg feels warm. In pregnancy, clots can occur in the major veins in the pelvis; the iliac vein. This can cause swelling of the whole leg and the leg can have a dusky blue appearance. This is a very serious clot and needs urgent treatment.
Local pain or tenderness can occur at the site of the clot, but in a major pelvic clot you can get pain in the flank or even lower abdomen.
When should I worry?
If one leg looks different from the other, you should think about a clot. I get concerned if there is persistent swelling or discolouration of the skin. Pain is not always a feature.
Symptoms of Pulmonary embolus
Classically a PE presents with chest pain, breathlessness, a fast heart rate and a cough. More serious clots can lead to dizziness or even collapse.
These symptoms can be difficult in pregnancy. Many women get more breathless as pregnancy progresses and they often notice their heart rate has increased. Even the chest pain can be difficult as many women get indigestion and heart burn. You should be concerned if the symptoms change quickly. Sudden onset of chest pain or breathlessness is a concern. The pain may be worse on taking a deep breath. Multiple small clots can present with worsening breathlessness over several days. You should take this seriously especially if you have noticed any signs in your legs suggesting a DVT.
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