Rus Articles Journal

The movement is complicated. Postnatal thromboses of

of the Illness of venous system of legs quite often occur at women after the delivery. Among such diseases - vein thromboses of the lower extremities. What this pathology and whether it is possible to avoid development of thrombosis is dangerous by?

What is venous thrombosis?

In the lower extremities of the person two systems of veins - hypodermic and deep are available. On hypodermic veins only the insignificant part of blood - only about 5% flows. but these veins can be exposed to varicose transformation. The main volume of blood - to 95% - passes on deep veins of a shin and a hip. Deep veins are located between muscles that protects them from uncontrolled expansion, so, and from development of varicosity. Blood climbs venous system from below up, from fingers of feet to heart, transferring blood poor in oxygen for enrichment to a small circle of blood circulation, to lungs.

every day to pump over the huge volume of blood, in veins all necessary is. The wall of a vein contains many gladkomyshechny fibers providing powerful reduction of a vein. Soyedinitelnotkanny fibers (collagen, elastin) carry out a fittings role, and valves in veins do not allow blood to come back to the lower departments after the next reduction.

Blood moves ahead on vessels with rather high speed, however sometimes in a gleam of a vein the blood clot which can close only part of diameter of a vessel is formed or as a stopper, completely to block off the blood traffic. It is also blood clot, and the state connected with developing of blood clot is called thrombosis. At the same time thrombosis varikozno of the changed veins of the lower extremities carries the name varikotromboflebit, and damage of deep veins - thrombosis of deep veins.


, very friable which are in a vein gleam, in the first 3 days of the existence; as a rule, on a blood clot top new layers actively accrue, increasing blood clot extent in the top direction. During this period of life of blood clot the probability of a separation of its part which with current of blood can be transferred to chambers of heart or that the most dangerous, to pulmonary arteries is very high. Obstruction even of small branches of a pulmonary artery can lead to switching off from breath of part of a lung that is direct threat of life. At pregnancy vein thromboses not a rarity therefore at this particular time efforts of doctors are directed to identification of risk of a tromboobrazovaniye, purpose of preventive actions. However often there is the following situation: childbirth took place safely; it would seem, all behind, the danger passed, no prevention is required any more. But at this particular time the risk of late complications of pregnancy and childbirth of postnatal thromboses increases.

of the Reason

First of all, development of postnatal thrombosis is connected with changes in the curtailing system of blood. During natural childbirth or Cesarean section blood is lost. The volume of blood loss can be a miscellaneous - from minimum (physiological) to considerable (pathological) that depends on a concrete situation. Anyway, the organism seeks to stop the further expiration of blood, developing a large number of the factors promoting increase of fibrillation by formation of clots - traffic jams in a gleam of vessels. And the more blood loss, the is more active these processes. Besides, at an otkhozhdeniye of a placenta or from - for mechanical damages of fabrics during operation also the wall of vessels is damaged, there is an ejection in blood of special proteins and enzymes an endoteliya (an internal vystilka of a vessel) that is also important for shift of processes towards fibrillation increase.

After the delivery the tone of vessels of a small pelvis and the lower extremities is lowered by

, veins did not manage to adapt to work in new conditions, Stagnation of blood, that is decrease in natural speed of a blood-groove yet, also starts tromboobrazovaniye mechanisms. An important role in development of postnatal venous thromboses is played also by the hormonal background which is sharply changing after the end of pregnancy.

the risk of development of venous thromboses in women with various pathologies of system of fibrillation which come to light even before pregnancy or during incubation of the kid is Especially big

. The probability of tromboembolichesky complications and in the presence of cardiovascular diseases, excess body weight, anemia, the postponed late toxicosis is high. The risk of thrombosis increases and at women in age group is after 40 years, in the presence of malignancies, an inactive way of life. Long, long childbirth, Cesarean section also contribute to complications. To group of very high risk on development of thromboses including in the postnatal period, women with a varicose illness of the lower extremities belong.

of Display of postnatal thrombosis

trouble Signs concerning veins of the lower extremities appear, as a rule, on 5 - 6 - y day, is more rare - on 2 - 3 - y to week after the delivery or Cesarean section. Clinical manifestations of this or that form of thrombosis depend on an arrangement trombomass in veins.

At defeat hypodermic, as a rule, already varikozno the changed veins in the first day of a disease the redness (hyperaemia) on the course of a trombirovanny vein appears, skin temperature over the trombirovanny, inflamed vein increases. Vienna at a touch is similar to a dense, painful cord. Walking and the movement by a leg cause pain too. The general health worsens, body temperature can increase.

Unlike thrombosis of superficial veins, display of thrombosis of deep veins more poor. The main symptom of trombotichesky damage of veins of deep system - emergence of the accruing dense, painful hypostasis which arrangement corresponds to localization trombomass in a vein of a shin and/or a hip. The holding apart pain which amplifies if to lower a leg down or some time is felt to stand. Skin of a leg can get a cyanotic shade or, on the contrary, to become dairy - white.

If the separation of part of blood clot to its introduction in a pulmonary artery happened, sharp cough, short wind, pain in a breast develop, the blood spitting - emergence a blood streak in a phlegm can begin at cough. In hard cases indications of the electrocardiogram change that is connected with violations of work of heart.

However for final statement of the diagnosis only of one survey have not enough

. It is necessary “to glance“ in vessels to understand an arrangement trombomass, their extent and danger of a separation of part of blood clot. “The gold standard“ of such diagnostics is the ultrasonic research of veins added with doppler sonography today that is the doctor - the diagnostician studies not only anatomic features of veins, but also character of a blood-groove (speed of passing of blood on vessels, the volume of the proceeding blood etc.) on these veins. Thus, the volume picture of an affected area of a venous network is created.

needs to be noted that thromboses of deep veins can proceed and absolutely asymptomatically. In similar cases happens that the person learns about the postponed disease years later, when performing ultrasonic research of vessels. Danger of the thrombosis which is not distinguished in time and cured that it can pass into other form of an illness - a posttromboflebitichesky syndrome. At this state considerable violation of a blood-groove on small arteries, veins and lymphatic vessels in a trombirovanny vein develops that leads to destruction of cells of hypodermic cellulose and skin, skin color change, emergence of dense hypostasis. In the absence of treatment by the final result of it about ¬ the tsessa will be developing of the chronic not healing wound located in the lower departments of a shin which carries the name “trophic ulcer“.


At the correct and in due time begun treatment thromboses can completely pass

. Remember: self-treatment or application of “national“ methods at thromboses at pregnant women or in the postnatal period is inadmissible! If there were symptoms similar on described above, surely address the phlebologist or the vascular surgeon.

Thromboses of hypodermic or deep veins of a shin can treat houses, but only under supervision of the expert, visiting him on an outpatient basis in due time. If trombomassa begin to extend quickly on a vein up or at once appear in hip veins - hospitalization and active therapy in specialized angiokhirurgichesky office is necessary.

In treatment of venous thromboses the most important - an integrated approach, that is simultaneous application of compression therapy, local treatment in the form of various compresses and ointments, reception of various medicines, and also physiotreatments. Only gels, ointments or compresses not to cope with this terrible disease.

the Indispensable condition of fast treatment is carrying special compression jersey of a certain degree of a compression. Compression golfs, stockings or tights reduce diameter of veins, normalizing and strengthening a blood-groove on roundabout veins - so-called collateral inflows of a trombirovanny vein. Venous stagnation disappears, the risk of development of an embolism of a pulmonary artery decreases. Use of elastic bandage - a task troublesome and not always effective as it is correct to apply a bandage happens very difficult, and the got-off bandage can worsen a condition of a leg. It is correct to pick up jersey necessary for you - and on length and degree of a compression - only the skilled expert can as well as to measure a leg for selection of jersey for the size. Therefore attempt to save and buy the first “antivaricose panty hoses“ in the local market or in a pharmaceutical booth at best will turn back useless expenditure of money.

As for the special anticurtailing, venotonichesky and other specific medicines which usually apply to treatment of venous thromboses, them in the postnatal period can be applied only on doctor`s orders as some of these drugs get into breast milk and can negatively influence the child`s organism.

the Main medicines at thromboses of deep veins or at heavy, widespread thromboses of hypodermic veins are anticoagulants (the medicines which are slowing down fibrillation). The most effective and safe of them - low-molecular heparins which reduce activity of the curtailing system, “diluting“ thus blood and interfering with formation of new blood clots. Preparations of this group can be applied to the feeding women, unlike other anticurtailing medicines - so-called indirect anticoagulants. The most known of such preparations - Varfarin. It is irreplaceable at long-term treatment of patients with heavy venous thromboses, however pregnant women cannot accept it in connection with an adverse effect on a fruit. Varfarin gets into breast milk in so insignificant quantity that has no effect on the curtailing system of the baby therefore reception of this preparation is quite compatible to breastfeeding.

needs to be noticed that prescription of antibiotics at thromboses is absolutely useless as the inflammatory phenomena in this case have aseptic character, that is are not connected with influence of microorganisms. For this reason at thromboses with success anti-inflammatory preparations - Diclofenac, Voltaren, Movalis in the form of ointments, gels, tablets or injection forms are applied. It is necessary to remember that at a lactation and pregnancy application of these drugs is extremely limited: it is possible only at very severe form of a disease and it is desirable at breastfeeding cancellation.

Venotonichesky preparations are also included into the standard of treatment of venous thromboses. The most known venotonik - Detraleks, Antistaks, Flebodia. Breastfeeding is contraindication for reception of these drugs.

As for physiotherapeutic treatment, at treatment of venous thromboses the cooling wrappings (cryowrappings), laser therapy, an electrophoresis and fonoforez with various gels and solutions are very effective

. Application of any kinds of massage, all wave types of physical therapy, hot wrappings, bathtubs, compresses is strictly forbidden.

Can avoid postnatal thrombosis?

the Main methods of prevention are simple and effective

. They should begin to be applied already during pregnancy planning. If on your legs expanded hypodermic veins or “vascular asterisks“ appeared - surely address the phlebologist to make the individual program of preparation. Perhaps, it will be necessary to carry out miniinvasive intervention on the changed veins - that is removal of the affected, functioning veins through punctures by the special tool. If you sometime already had venous thrombosis, by all means inform on it the gynecologist.

Try to learn

before pregnancy about all problems of the health - visit not only the gynecologist, but also the therapist, the ENT SPECIALIST - the doctor (as chronic infections can also influence processes of a tromboobrazovaniye), if necessary you descend to the endocrinologist. During pregnancy move more, swim, attend gymnastic classes for pregnant women, you wear convenient shoes. The contrast shower for legs is very effective for reduction of load of veins, activization of a shelter - and a limfoobrashcheniye, reduction of hypostases.

For the pregnant women having the varicosity obligatory is wearing special compression tights or stockings, and in certain cases (at polycarpous pregnancy or substantial increase of body weight) it is necessary to carry a special bandage in addition. If at the woman revealed a varicose illness, from the second trimester of pregnancy reception of venotonik - Antistaks, Vazoketa, Flebodiya, Detraleks is possible. However only the doctor can appoint them.

When carrying out inspection at all pregnant women the condition of indicators of the curtailing system by which it is possible to determine risk of emergence of thrombosis soon is defined by

. At identification of high probability of such complication purpose of injection anticoagulants - Fraksiparina is very effective. Kleksana, Fragmin. They are harmless to mother and the kid and at the same time considerably reduce a possibility of formation of blood clot.

the Moment of childbirth - the most responsible and dangerous in the development plan various, including tromboembolichesky, complications. All women at whom the high risk of a tromboobrazovaniye was revealed earlier need to go for childbirth (or for operation of Cesarean section) only in special protivoembolichesky stockings or elastic bandage. Doctors if necessary will enter to the woman certain drugs which will slow down excessively active processes of folding. After the delivery, if the condition of young mother allows, it is necessary as soon as possible to begin to rise, go. However protivoembolichesky stockings in this case need to be replaced either with bandage, or with habitual compression jersey. It is necessary to carry it after the delivery or during the postoperative period of not less of 1 - 2 months.

Remember that venous thromboses can quite be avoided if to show consideration for the health even prior to pregnancy.