Nursing Care Management 109

Care for
Mother and
Child at Risk
Prepared by:

Sharmaine S. Pero, RN
Clinical Instructor
 Learning outcomes:

 Students will be able to discuss the signs and

symptoms of DVT
 Identify nursing care management for DVT
 DVT
(Deep Vein Thrombosis)
What is deep vein thrombosis?

Deep vein thrombosis or DVT occurs when blood

clot(s) form in the deep-seated veins. It is common to
occur in the legs during pregnancy due to increased
pressure or strain on the lower body. These blood
clots can have serious consequences when not
attended in time.
Why does it occur to
Pregnancy?
Hormonal changes- can make the veins and valves smooth that
can lead to impaired functioning.

Increased blood volume while the number of veins remains the

same

Significant increase in weight

Clotting factor of a woman in the final months increases.

Sometimes, the clotting proteins can increase a lot more than
usual and the blood cells can clump together to form clots in the
veins.
How to diagnose?
Diagnosis:
To diagnose , your doctor will ask you about your
symptoms. You'll also have a physical exam so that your
doctor can check for areas of swelling, tenderness or
changes in skin color.

D-dimer blood test. D dimer is a type of protein produced by blood

clots. Almost all people with severe DVT have increased blood levels
of D dimer. A normal result on a D-dimer test often can help rule
out PE

Duplex Ultrasound. This noninvasive test uses sound waves to create

pictures of how blood flows through your veins. It's the standard test
for diagnosing DVT. For the test, a technician gently moves a small
hand-held device (transducer) on your skin over the body area being
studied. Sometimes a series of ultrasounds are done over several
days to determine whether a blood clot is growing or to check for a
new one.
Venography. A dye is injected into a large vein in your foot or ankle.
An X-ray creates an image of the veins in your legs and feet, to look
for clots. The test is invasive, so it's rarely performed. Other tests,
such as ultrasound, often are done first.

Magnetic resonance imaging (MRI) scan. This test

may be done to diagnose DVT in veins of the
abdomen.
Clinical manifestations:
Intense pain, cramping, burning sensation, and
discoloration of the skin around the blood clot.
Risk Factors:
Deep vein thrombosis usually doesn’t cause any major
symptoms. It doesn’t pose any risk to the unborn baby unless
any serious complications arise.

Carrying one or more baby

Bleeding after delivery
Fertility treatment (hormones)
Inherited blood clotting problems
>35 y.o
Cesarean Section
Having another surgery or injury
Smoking
Prolonged sitting down
Certain medical conditions including heart condition,
cancer or diabetes
The three main goals of DVT
are:
Treatment and
•Prevent the clot from getting bigger.
•Prevent the clot from breaking loose and
Management
traveling to the lungs.
•Reduce your chances of another DVT
Management:
Secondary PPH

The treatment of deep vein thrombosis during pregnancy is not

very complex. You may have to consult a hematologist and a
vascular specialist along with your regular gynecologist. The
doctors will prescribe anticoagulation therapy to dissolve the
blood and provide fast relief from the symptoms.

In anticoagulation therapy, you will have to take heparin and

some other injections. Heparin prevents the existing clot from
growing, stops new clots from forming, and dissolves the existing
clots by making the blood thinner.

You may have to take these injections for the rest of your
pregnancy. The doctor will stop the therapy 2-3 weeks before
your delivery. However, there is a great risk of deep vein
thrombosis postpartum. Therefore, you may have to take heparin
for about 6 weeks after delivery as well.
How to prevent DVT?
Make sure that you avoid wearing heels and choose comfortable
flat footwear to avoid excess pressure on the veins and calf
muscles.

Keep yourself hydrated. Having caffeinated and carbonated beverages that

have dehydrating effects on the vascular system, making them prone to
deep vein thrombosis.

If you have a history of deep vein thrombosis, you can consult

your doctor and take some preventive anti-coagulating medicines.

Keep your legs moving. This will ensure the proper circulation of
blood in the veins and prevent the blood cells from clumping
together.

Wear compression stockings for 8-10 hours a day during

pregnancy after consulting the doctor. Remember to remove them
while sleeping.
Thank You