Postpartum women are at risk for thromboembolic disease due to clotting factors that increase during pregnancy and remain elevated; the fetal head exerting pressure on the veins of the lower extremities, causing them to dilate; and inactivity during labor and delivery.
Predominant sites of thrombus formation include the legs, thighs, and pelvis. Management aims to prevent or recognize early symptoms of the disease, prevent further complications, and provide pain relief.
Pathophysiology
A thrombus occurs when an alteration in the epithelial lining causes platelet aggregation and consequent fibrin entrapment of red and white blood cells and additional platelets. Thrombus formation is more rapid in areas where blood flow is slower, resulting from greater contact between platelet and thrombin accumulation. The rapidly expanding thrombus initiates a chemical inflammatory process in the vessel epithelium, which leads to fibrosis. The enlarging clot can partially or totally occlude the vessel lumen, or it can detach and embolize to lodge elsewhere in the systemic circulation.
Complications
■ Pulmonary embolism
Assessment
Health perception and management
■ Known risk factors for thrombophlebitis
Activity and exercise
■ Recent prolonged immobility
Cognition and perception
■ Acute onset of local pain (relieved by elevation of extremity), tenderness, edema, erythema, warmth, induration, or febrile reaction
Physical examination
Integumentary
■ Local erythema
■ Warmth
■ Local induration
■ Ulceration
Cardiovascular
■ Local edema
■ Engorged vessel
■ Positive Homans' sign
Diagnostic studies
■ d-dimer level is elevated.
■ Doppler ultrasound blood flow detector test shows evidence of narrowing or closure.
■ Venography may indicate loss of significant venous return.
Circulatory care: Venous insufficiency; Circulatory precautions; Embolus care: Peripheral; Embolus care: Pulmonary; Emergency care; Oxygen therapy
Teaching checklist
■ Signs and symptoms of recurring thrombophlebitis
■ Antiembolism stockings
■ Purpose, dosage, administration schedule, food and drug interactions, and adverse effects requiring medical attention for all discharge medications
■ Activity level permitted
■ Risk factor modification
■ Procedure for obtaining follow‑up laboratory tests such as prothrombin time
■ Date, time, and location of follow‑up appointments
■ Reportable signs and symptoms such as those of pulmonary embolism
■ Reasons for contacting the practitioner
Share This to Your Love Ones Share information!