Miscarriage | Warning Signs, Myths, Symptoms and Causes

What causes bleeding in early pregnancy?

What is a miscarriage?

Prof Lesley Regan

Many women may have a small amount of bleeding (spotting) at the time of their missed period. This is sometimes called an ‘implantation bleed’. It happens when the fertilised egg implants itself in the wall of your womb (uterus). It is harmless.

The most common cause of bleeding after the time of the missed period is miscarriage. Miscarriage is the loss of a pregnancy at any time up to the 24th week. A loss after this time is called a stillbirth. At least 8 miscarriages out of 10 actually occur before 13 weeks of pregnancy. These are called early miscarriages. A late miscarriage is one that happens from 13 weeks to 24 weeks of pregnancy.

A less common cause of bleeding in pregnancy is an ectopic pregnancy. This is a pregnancy that occurs outside the womb. It occurs in about 1 in 100 pregnancies.

Always tell your doctor if you have vaginal bleeding when you are pregnant

How common is miscarriage?

Miscarriage accounts for over 40,000 hospital admissions in the UK each year. About 1 in 4 recognised pregnancies end in miscarriage. Far more pregnancies than this do not make it – as many as half. This is because in many cases a very early pregnancy ends before you miss a period and before you are even aware that you are pregnant.

The vast majority of women who miscarry go on to have a successful pregnancy next time. Recurrent miscarriages (three or more miscarriages in a row) occur in about 1 in 100 women.

What causes miscarriage?

It is thought that most early miscarriages are caused by a one-off problem with the chromosomes of the developing baby (fetus) in the womb. Chromosomes are the structures that contain the genetic information that we inherit from our parents. If a baby (fetus) doesn’t have the correct chromosomes it can’t develop properly and so the pregnancy will end. This is usually a one-off mistake and rarely occurs again. Such genetic mistakes become more common when the mother is older – that is, over 35 years old. This means women aged over 35 years who are having children are more likely to have a miscarriage. This may also be why, if your partner is aged over 45 years, you are more likely to have a miscarriage, even if you are under 35 years old.

You are also at a greater risk of having a miscarriage if you:

Investigations into the cause of a miscarriage are not usually carried out unless you have three or more miscarriages in a row. This is because most women who miscarry will not miscarry again. Even two miscarriages are more likely to be due to chance than to some underlying cause. Even after three miscarriages in a row, more than seven women out of every ten will not have a miscarriage next time around.

Some myths about the cause of miscarriage

After a miscarriage it is common to feel guilty and to blame the miscarriage on something you have done, or failed to do. This is almost always not the case. In particular, miscarriage is not caused by lifting, straining, working too hard, constipation, straining at the toilet, sex, eating spicy foods or taking normal exercise.

There is also no proof that waiting for a certain length of time after a miscarriage improves your chances of having a healthy pregnancy next time.

What is a threatened miscarriage?

It is common to have some light vaginal bleeding at some point in the first 12 weeks of pregnancy. This does not always mean that you are going to miscarry. Often the bleeding settles and the developing infant is healthy. This is called a threatened miscarriage. You do not usually have pain with a threatened miscarriage. If the pregnancy continues, there is no harm done to the baby.

In some cases, a threatened miscarriage progresses to a miscarriage.

What are the symptoms of miscarriage?

The usual symptoms of miscarriage are vaginal bleeding and lower tummy (abdominal) cramps. You may then pass something from the vagina, which often looks like a blood clot or clots. In many cases, the bleeding then gradually settles. The time it takes for the bleeding to settle varies. It is usually a few days but can last two weeks or more. For most women, the bleeding is heavy with clots but not severe – it is more like a heavy period. However, the bleeding can be extremely heavy in some cases.

In some cases of miscarriage, there are no symptoms. The baby stops developing or dies but it remains in the womb. You may have no pain or bleeding. You may no longer experience symptoms to suggest you are pregnant (for example, morning sickness or breast tenderness). This type of miscarriage may not be found until you have a routine ultrasound scan. This may be referred to by doctors as a missed miscarriage (also called early fetal demise, an empty sac or a blighted ovum).

The typical pain with a miscarriage is crampy lower tummy pain. If you have severe, sharp, or one-sided tummy pain, this may suggest ectopic pregnancy. This is a pregnancy that develops outside the womb. The symptoms of an ectopic pregnancy usually occur at around 6-8 weeks of pregnancy. There may be very little blood lost, or the blood may look almost black. Other symptoms may also occur such as diarrhoea, feeling faint and pain when you open your bowels. Sometimes there are no symptoms until you collapse because of heavy bleeding into the inside of your tummy (internal bleeding). This is called a ruptured ectopic pregnancy and is a potentially life-threatening situation that needs emergency surgery. You should call an ambulance or go to your nearest Accident and Emergency department if you are worried that you may have an ectopic pregnancy.

Do I need to go to hospital?

You should always report any bleeding in pregnancy to your doctor. It is important to get the correct diagnosis, as miscarriage is not the only cause of vaginal bleeding. However, if you are bleeding very heavily or have severe tummy (abdominal) pain when you are pregnant, call for an ambulance immediately.

Most women with bleeding in early pregnancy are seen by a doctor who specialises in pregnancy – an obstetrician. This is often in an Early Pregnancy Assessment Unit at your local hospital. It is usual to have an ultrasound scan. This is usually done by inserting a small probe inside your vagina. This helps to determine whether the bleeding is due to:

• A threatened miscarriage (a heartbeat will be seen inside the womb (uterus)).
• A miscarriage (no heartbeat is seen).
• Some other cause of bleeding (such as an ectopic pregnancy – see above).

If it is unclear from your ultrasound scan whether the pregnancy is healthy or not then you may be asked to return for a repeat scan in one to two weeks.

The usual symptoms of miscarriage are vaginal bleeding and lower tummy (abdominal) cramps

Do I need any treatment?

Once the cause of bleeding is known, your doctor will advise on your treatment options.

Natural or expectant management

Many women now opt to ‘let nature take its course’. This is called expectant management. In most cases the remains of your pregnancy are passed out naturally and the bleeding will stop within a few days after this, although can take up to 14 days to occur. However, if your bleeding worsens and becomes heavier or does not settle then you may be offered alternative treatment. Expectant management may not be offered if you have had a miscarriage in the past or if you have a bleeding disorder or any evidence of infection. You may decide that you would prefer to have a definitive treatment rather than taking this approach.

If your bleeding and pain settle then you should perform a pregnancy test after three weeks. If this is positive then you will need to see your doctor for an assessment.

Treatment with medicines

In some cases you may be offered what doctors call medical treatment for your miscarriage. That is, you may be offered a tablet to take either by mouth or to insert into your vagina. The medicine helps to empty your womb (uterus) and can have the same effect as an operation. You do not usually need to be admitted to hospital for this. Some women experience quite severe tummy (abdominal) cramps with this treatment.

You may continue to bleed for up to three weeks when medical treatment is used. However, the bleeding should not be too heavy. Many women prefer this treatment because it usually means that they do not need to be admitted to hospital and do not need an operation.

You should perform a pregnancy test three weeks after receiving medical treatment. If this is positive then you will need to see your doctor for an assessment.

An operation may be offered to you, however, if the bleeding does not stop within a few days, or if the bleeding is severe.

Treatment with an operation

If the options above are not suitable or are not successful then it is likely you will be offered an operation. The operation most commonly performed to remove the remains of your pregnancy is called surgical management of miscarriage (SMM). In this operation, the neck of your womb (the cervix) is gently opened and a narrow suction tube is placed into your womb to remove the remains of your pregnancy. This operation takes around 10 minutes.

This may be performed without the need for a general anaesthetic in some cases. This is called a manual vacuum aspiration (MVA). Your doctor will be able to discuss the procedure in more detail with you.

A few women develop an infection after having this operation. If you experience a high temperature (fever), any offensive-smelling vaginal discharge or abdominal pains then you should see a doctor promptly. Any infection is usually treated successfully with antibiotics.

Feelings

Many women and their partners find that miscarriage is distressing. Feelings of shock, grief, depression, guilt, loss and anger are common.

It is best not to bottle up feelings but to discuss them as fully as possible with your partner, friends, a doctor or midwife, or anyone else who can listen and understand. As time goes on, the sense of loss usually becomes less. However, the time this takes varies greatly. Pangs of grief sometimes recur out of the blue. The time when the baby was due to be born may be particularly sad.

Signs & symptoms – The Miscarriage Association

When you see a miscarriage portrayed on television or a film, you often see a woman suddenly overcome with excruciating pain and then collapsing in a pool of blood. In fact, that’s not what happens to most women.  We talk below about pain, bleeding, spotting and other symptoms – and about having no symptoms at all.

Pain, bleeding or spotting

Pain in pregnancy doesn’t always mean that there is a problem.

Some women feel discomfort as ligaments stretch with the growing baby. Many women experience backache, especially as the pregnancy progresses. And abdominal pain may be due to a stomach upset or constipation.

But if you are worried, and especially if you have severe abdominal or one-sided pain or pain in your shoulders, it might be wise to contact your GP and explain what is happening. That’s especially important if you have previously had an ectopic pregnancy.

Similarly, if you have pain when you try to move your bowels (pass a motion), you might also want to ask if you might be referred for an ultrasound scan to rule out the possibility of ectopic pregnancy.

Bleeding in pregnancy may be light or heavy, dark or bright red.  You may pass clots or “stringy bits”.  You may have more of a discharge than bleeding. Or you may have spotting, which you notice on your underwear or when you wipe yourself.

Spotting or bleeding may be continuous or it might be on and off, perhaps over days or even weeks.  It doesn’t necessarily mean that you are miscarrying or that you will miscarry: one study [1] of women attending an Early Pregnancy Unit because of bleeding in pregnancy showed that about half of them had continuing pregnancies.  So if you have bleeding or spotting, you may still go on to have a healthy pregnancy.

How can I know what’s happening?

If you have vaginal bleeding or spotting at any time during your pregnancy, it is worth talking first to your GP. S/he may refer you to hospital for an ultrasound scan to try to see whether the pregnancy is developing as it should.

During the coronavirus pandemic, many GP practices are under severe strain, so you might need to contact 111 rather than your GP.

Many hospitals now have a specialist Early Pregnancy Unit or Emergency Gynaecology Unit (EPU, EPAU, EPAC or EGU).  They usually require a GP referral but you might also be able to contact them direct for advice. You can find information about your nearest Early Pregnancy Unit here or you could just contact the nearest hospital that has maternity facilities.
During the coronavirus pandemic, most early pregnancy or emergency gynaecology units are assessing patients by phone to begin with, to reduce the number of people coming to hospital.  Be clear and honest in describing your symptoms so they can give you the best advice on coming in or not.

If you have acute, sharp abdominal pain, pain in your shoulders and/or pain on moving your bowels, contact your GP, EPU or midwife or if necessary, go to A&E (Casualty department). Tell them that you are pregnant and describe your symptoms so they can arrange an emergency scan.

If you have previously had an ectopic pregnancy, ask your GP or EPU for an early scan to make sure the baby is in the right place.

My GP won’t refer me for a scan…

If your GP won’t refer you for a scan, it might be because it is too early to be able to see even a healthy pregnancy on scan (see our section on ultrasound scans).  It might be due to restrictions on scans during the coronavirus pandemic.  But it might be that s/he takes a “wait and see” approach and advises you to stay home and put your feet up, or to stay in bed – or just to go about your normal routine.

You might find this very frustrating and even frightening, especially if you are feeling very anxious:

• If it’s your first pregnancy, you may worry because you don’t know what is normal and what isn’t.
• If you have had a previous healthy pregnancy, you may worry because this pregnancy is not progressing in the same way.
• And if you have previously lost a baby, you are likely to be particularly anxious because of what happened last time.

But I really want a scan…

If you want a scan because of bleeding or spotting, and you can’t get an appointment at an Early Pregnancy or Emergency Gynaecology Unit, you could go to your nearest Accident & Emergency Department.  Bear in mind that you might have a long wait and that they may not be able to scan you there and then. In addition, the coronavirus pandemic is putting additional strain on many NHS services, including emergency services and unless you have extremely heavy bleeding or acute pain, it might be best to phone 111 instead.

If you want a scan for reassurance, you might decide to go for a private scan (try putting “early pregnancy scan” and the name of the nearest town into your search engine).  Clinic standards do vary so it is best to check on each clinic’s website:

• if their sonographers (scan operators) are qualified radiographers, or midwives or nurses who are trained in ultrasound scanning
• if they offer diagnostic scans (ones that check for a hearbeat and other signs of a normally developing pregnancy)
• if they state that they refer women to NHS services if there or any concerns or uncertainties
• if they are registered with the Care Quality Commission (CQC) if in England, or adhere to the same standards if in other countries. 

Some private clinics are limiting their appointments during the coronavirus pandemic but most are still operating.

What should I do?

Whatever you do – have a scan, stay in bed or continue your usual routine – it’s very unlikely to make a difference to the outcome of your pregnancy.  Sadly, if the bleeding is because the pregnancy is miscarrying, it is very unlikely indeed that anything can be done to stop this. (The only exception might be if the bleeding occurs in the last few months of the pregnancy).

Resting in bed might slow down any bleeding, but when you get up, perhaps to go to the toilet, it’s likely to start again.  That’s not your fault – it’s just because of gravity. (Again, the only exception might be in the later months of pregnancy.)

Some people prefer to rest, others to continue their usual routine. It makes sense to do what feels right for you.

Other symptoms – or lack of…

It’s common for women to have certain symptoms in early pregnancy: feeling or being sick, tiredness, breast tenderness, a need to go to the toilet more often etc.  But if you don’t have any of those symptoms – or if you do and then they suddenly disappear – it doesn’t necessarily mean that you are likely to miscarry.

On the other hand – and this is confusing – having all of those symptoms doesn’t guarantee that all is or will be well. It can be very difficult to make sense of symptoms or their absence.

If you are not sure, or something doesn’t feel right for you, speak to your doctor or get in touch with us to talk things through.

[1] Grant A., 1997, A study of the psychological responses of women immediately after spontaneous and threatened miscarriage Leeds University Hospital, St James’s, Unpublished dissertation

Ultrasound scans – The Miscarriage Association

Ultrasound scans in pregnancy may be routine or they may be offered because of pain or bleeding or because of problems in a previous pregnancy.

There are two ways of doing an ultrasound scan.

In early pregnancy, especially before 11 weeks, it is usual to have a trans-vaginal (internal) scan, where a probe is placed in the vagina.  This gives the clearest and most accurate picture in early pregnancy.  It may also be offered after 11 or 12 weeks if a trans-abdominal scan doesn’t give a clear enough picture.

From 11 or 12 weeks, including at the routine booking-in scan, it is more common  to have a trans-abdominal scan.  The person doing the scan spreads a special gel on your lower abdomen (below your belly button and above the line of pubic hair).  He or she then moves the scanner over the gel, sometimes pressing down, until the uterus (womb) and pregnancy can be seen.

What if I don’t want an internal scan?

If you don’t want a trans-vaginal scan, you can ask for a trans-abdominal scan. That may give some information about your pregnancy, but it is less clear than an internal scan and that could possibly delay diagnosis.

Can ultrasound scans harm the baby?

There is no evidence that having a vaginal or an abdominal scan will cause a miscarriage or harm your baby. If you bleed after a vaginal scan, it will most likely be because there was already blood pooled higher in the vagina and the probe dislodged it.

When can I have an ultrasound scan? When can you see the baby’s heartbeat?

An ultrasound scan may be able to detect a pregnancy and a heartbeat in a normal pregnancy at around 6 weeks, but this varies a great deal and isn’t usually advised.  All too often, a scan at 6 weeks shows very little or nothing, even in a perfectly developing pregnancy, whereas waiting a week or 10 days will make the findings much clearer.

Routine scans

Most pregnant women are referred for their first routine (or booking) ultrasound scan somewhere between 11 and 14 weeks of pregnancy.  The purpose of the scan is:

• to confirm that there is a heartbeat
• to assess the baby’s size and growth
• to estimate the delivery date and
• to check whether there is one baby, or twins or more.

Some women may be offered a nuchal scan between 11 and 14 weeks. The purpose of this scan is to try to detect some chromosome abnormalities, such as Downs syndrome.

Most hospitals also offer a further anomaly scan at 20 weeks, making a more detailed check of the baby’s development.

The coronavirus pandemic is leading to some restrictions and delays in routine scanning appointments (see also here).  Your hospital or midwife should let you know if there are any changes in your case.

You can find out more about routine, nuchal and anomaly scans at the website of the charity ARC – Antenatal Results and Choices

Sadly…

Sadly, sometimes these scans show that the baby has died, possibly some weeks earlier and often without any signs or symptoms such as bleeding or pain. This is often called a “missed”, “silent” or “delayed” miscarriage. This can come as a considerable shock and it may take time before you can take this information in.  You can find information about missed miscarriage here.

You may also have to make some difficult decisions about how to manage the miscarriage process. You can read more about this here.

Early scans

You may be referred for an early scan because of vaginal bleeding or spotting, or possibly because you have had problems in a previous pregnancy.

The best time to have a scan is from about 7 weeks’ gestation when it should be possible to see the baby’s heartbeat in a normal pregnancy. But it can be hard to detect a heartbeat in early pregnancy and in those cases it can be hard to know whether the baby has died or not developed at all, or whether it is simply smaller than expected but still developing.

For that reason, you may be asked to return for another scan a week or so later.  At that time, the person doing the scan will be looking for a clear difference in the size of the pregnancy sac and for a developing baby and a heartbeat.

Sometimes, it can take several scans before you know for sure what is happening.  It can be very stressful dealing with this uncertainty – some women describe it as being “in limbo”.  You may need to find some support for yourself if this happens to you.

There’s a heartbeat, but I’m still bleeding…

If the scan does pick up a heartbeat and the baby appears to be the right size according to your dates, this can be very reassuring, even if you are still bleeding.

Research amongst women with a history of recurrent miscarriage has shown that those who saw a heartbeat at 6 weeks of pregnancy had a 78% chance of the pregnancy continuing.  It also showed that seeing a heartbeat at 8 weeks increased the chance of a continuing pregnancy to 98% and at 10 weeks that went up to 99.4%.

The numbers may be even more positive for women without previous miscarriages.

So things could still go wrong and sadly sometimes do, but as long as there is a heartbeat, the risk of miscarriage decreases as the weeks go by.

Other investigations

In some cases, if there is no sign of a pregnancy in the uterus, you may be given a blood test and possibly asked to return two days later for a repeat test.

These blood tests measure the level of the pregnancy hormone ßhCG. In a normally developing pregnancy the hormone levels roughly double about every 48 hours and if the pattern is different, this can help to identify what is happening to the pregnancy.

If there is no sign of a pregnancy in the uterus and you have symptoms that suggest ectopic pregnancy, you are more likely to have both a blood test and an investigation called a laparoscopy, which is done under general anaesthetic. You can read more about this here and in our leaflet Ectopic pregnancy.

Ultrasound scan results – and what they mean

The ultrasound scan may show:

• A viable ongoing pregnancy.  There is a heartbeat (or heartbeats if it’s a twin or multiple pregnancy) and the pregnancy is the “right size for dates” – that is, the size that would be expected based on the first day of your last period.  Those are positive signs, but if you continue to bleed, you may need a further scan in a week or two to check what’s happening.

• An ongoing pregnancy that suggests a problem.  The pregnancy may be much smaller than it should be according to dates or the heartbeat might be particularly slow or faint.  Perhaps there is something that suggests a problem with the baby’s development. With a twin or multiple pregnancy, the scan may show that one (or more) baby has a heartbeat and one (or more) doesn’t.  You may be asked to come back for another scan, possibly in a week or two when things should be clearer.

• A pregnancy of unknown location (PUL).  The pregnancy is not visible and it’s not clear what is happening.  You may be asked to come back for another scan, possibly in a week or two when things should be clearer.  Or if the doctor thinks you might have an ectopic pregnancy, you will have blood tests and/or a laparoscopy (keyhole surgery to look inside the abdomen).

• A complete miscarriage.  The pregnancy has miscarried.  There may still be a small amount of pregnancy tissue or blood in the uterus.

• A non-viable pregnancy. This means a pregnancy that hasn’t survived but hasn’t yet miscarried.  You may hear this described in one of the following ways:

• • Missed miscarriage (also called silent or delayed miscarriage or early embryonic demise) This is where the baby has died or failed to develop but your body has not miscarried him or her. The scan picture shows a pregnancy sac with a baby (or fetus or embryo) inside, but there is no heartbeat and the pregnancy looks smaller than it should be at this stage.  You may have had little or no sign that anything was wrong and you may still feel pregnant.  You might still have a positive pregnancy test.

• • Blighted ovum or anembryonic pregnancy (which means a pregnancy without an embryo). This is a rather old-fashioned way of describing a missed miscarriage (see above). The scan picture usually shows an empty pregnancy sac.

• • Incomplete miscarriage The process of miscarriage has started but there is still pregnancy tissue in the uterus (womb) and you may still have pain and heavy bleeding.

In all of these situations, the pregnancy will fully miscarry with time, but there are several ways of managing the process. You may be offered a choice, or the hospital might make a recommendation. In most cases, you should be able to have time to think about what you can best cope with. You can read more here.

The ultrasound scan might show

• An ectopic pregnancy. This means a pregnancy that is developing outside the uterus (Ectopic means “out of place”). Ectopic pregnancies usually develop in one of the Fallopian tubes, but they can develop elsewhere inside the abdomen.

• A molar pregnancy. This is a pregnancy where the baby can’t develop but the cells of the placenta grow very quickly. It can’t always be diagnosed on scan so you might find out only after the miscarriage.

Symptoms & diagnosis – The Miscarriage Association

The main symptoms of miscarriage are vaginal bleeding or spotting, with or without abdominal pain or cramping.  But sometimes there are no obvious signs at all.

Pain, spotting and bleeding

Bleeding in pregnancy may be light or heavy, dark or bright red.  You may pass clots or “stringy bits”.  You may have more of a discharge than bleeding. Or you may have spotting, which you notice on your underwear or when you wipe yourself.

Spotting or bleeding may be continuous or it might be on and off, perhaps over days or even weeks.  It doesn’t necessarily mean that you are miscarrying or that you will miscarry [1], but it’s always worth checking.

Pain, like bleeding, can vary.  Abdominal pain might be due to a stomach upset or constipation, and backache is common in normal pregnancy, especially as the weeks go by.  But if you have bleeding or spotting as well as pain, that might be a sign of miscarriage.

If you have acute, sharp abdominal or one-sided pain or pain in your shoulders, and/or pain on moving your bowels, contact your GP, Early Pregnancy Unit or, if necessary, go to A&E (Casualty).  Tell them you are pregnant and describe your symptoms so that they can arrange an emergency scan.  That’s especially important if you have previously had an ectopic pregnancy.

Lack or loss of pregnancy symptoms

Lack or loss of pregnancy symptoms can also sometimes be a sign of miscarriage, but like pain and bleeding, that doesn’t necessarily mean there is a problem.  Some women have very little in the way of pregnancy symptoms, and many feel differently in different pregnancies.

But if you have strong pregnancy symptoms which suddenly reduce or stop well before 12 weeks of pregnancy, that might mean that hormone levels are dropping.  You may want to do another pregnancy test and/or talk to your GP about perhaps having a scan.

In some cases, there are no signs at all that anything is wrong and miscarriage is diagnosed only during a routine scan.  We say more about this here.

Diagnosing miscarriage

Miscarriage is usually diagnosed or confirmed on an ultrasound scan or scans. The person doing the scan needs to be absolutely certain that the baby (or fetus or embryo) has died or not developed, and they may need more than one scan to confirm that – usually with a gap of at least one week.

Having to wait can be very upsetting but it means that there is no risk of damaging an ongoing pregnancy.

In some cases, especially in later (second trimester) pregnancy, there may be no need for the miscarriage to be confirmed by scan.  The physical process of bleeding, pain and passing a recognisable pregnancy sac or delivering a baby, is confirmation in itself.  Doctors may still advise a scan in some cases just to ensure that the miscarriage is complete.

[1] In Grant A., 1997, A study of the psychological responses of women immediately after spontaneous and threatened miscarriage Leeds University Hospital, St James’s (Unpublished dissertation), it was noted that about half of the women attending an Early Pregnancy Unit because of bleeding in pregnancy had continuing pregnancies.

Blood clots during pregnancy: Symptoms and prevention

There is nothing quite like the feeling of not being able to catch your breath. When I was 22 years old, I had trouble breathing. I eventually went to the hospital where they diagnosed me with a pulmonary embolism—a blood clot in the lung, a rare condition for a person of my age. I later learned that I had a genetic condition that increased my likelihood of developing a blood clot. 

My clot was broken up and I was treated for some time afterward with blood thinners. But, I knew that in the future I would need to take proactive measures if I were to become pregnant or have surgery. Blood clots during pregnancy are a concern for many expectant mothers, but as I learned, it is possible to manage your high risk. 

The cause of blood clots during pregnancy

Blood clotting is a natural process that occurs when blood clumps together to form a gelatinous mass. This process protects your body from bleeding too much when you’ve been injured, as clotting can seal off the wound. In pregnancy, the body is primed to clot to prevent blood loss during delivery. While this is important, blood clotting (called thrombosis) can also cause complications, especially when it happens internally in your blood vessels. 

This can happen in any blood vessel in the body. However, the most common place for abnormal blood clots to occur is in the deep veins of your legs. This is called deep vein thrombosis (DVT). The major concern is that the clot can break free and travel to other parts of the body (lungs are most common), which can lead to serious complications or even death. 

It is estimated that pregnant women may be up to five times more likely to experience blood clots than non-pregnant women. Hormonal changes in pregnancy, as well as increased pressure on the veins restricting blood flow, can cause blood clots.

A blood clot in the lung, also known as a pulmonary embolism, is a leading cause of maternal death for pregnant women in the U.S., according to the UNC Hemophilia and Thrombosis Center. And the risk of developing blood clots isn’t just during the pregnancy—it continues to be a concern for approximately six weeks after giving birth. Delivery by cesarean section (c-section) nearly doubles your risk after birth.

Who is at risk for blood clots during pregnancy?

Anyone can develop a blood clot during pregnancy, however it is more likely under certain conditions, or for those who already have some risk factors. 

“Pregnant women are at a higher risk of DVT for several reasons,” says Nisha Bunke, MD, a vein specialist and diplomate of the American Board of Venous and Lymphatic Medicine, “a hypercoagulable state (proteins in the blood make it thicker, and more likely to form clots), an enlarged uterus may put pressure on the veins in the lower abdomen, and the hormones decrease venous tone.” 

Dr. Bunke adds that “some women have risk factors that increase their risk of DVT even greater during pregnancy, like inherited blood clotting disorders, medical conditions such as lupus and sickle cell disease, obesity, immobility and age over 35.”

Other factors that may increase the risk of clotting are:

• Family history of blood clots
• Multifetal gestation (twins or more)
• Traveling long distances (sitting for long time periods)
• Prolonged stillness, like bed rest during pregnancy
• Other medical conditions

Additionally, some people may be predisposed to getting blood clots if they have thrombophilias, a group of disorders that increase a person’s risk of thrombosis (abnormal blood clotting). This was my case, with a condition known as Protein C Deficiency. 

Symptoms of DVT in pregnancy

“The most obvious symptom of DVT is swelling and heavy pain or extreme tenderness in one of your legs,” says Dr. Kendra Segura, MD, a board-certified OBGYN in Southern California. Other symptoms include:

• Pain in the legs while in motion
• Skin feels warm or tender
• Redness, usually behind the knee 
• Swelling 
• A heavy, painful sensation

Dr. Segura says if you are experiencing these symptoms you must seek medical attention immediately. Your healthcare provider may require further testing because “it’s not always easy to diagnose DVT in pregnancy from symptoms alone,” according to Dr. Segura.

Although the development of blood clots during pregnancy can be dangerous, they are still fairly uncommon—and treatable. Anticoagulant medications (also known as blood thinners) can be prescribed to help to break up the clot and get the blood moving again. Dr. Segura says that both Heparin and low-molecular-weight Heparin are safe in pregnancy for mother and baby. The main side effect of taking blood thinners is an increased risk of bleeding, so your doctor will monitor you as the pregnancy progresses. 

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Vaginal bleeding and blood clots in pregnancy

Sometimes during pregnancy, women pass blood clots vaginally, which is an understandable cause of concern. 

In the first trimester of pregnancy (first three months), women may bleed as a result of implantation (where the fertilized egg attaches to the uterine wall) or due to early pregnancy loss (miscarriage). While not all cases of passing clots within the first 12 weeks of pregnancy are indicative of a loss, vaginal bleeding during pregnancy is a cause of concern, so it’s best to follow up with your obstetrician, gynecologist, or another healthcare professional.

In the second and third trimesters, bleeding could be caused by a variety of factors. These may include miscarriage, preterm labor, or obstetric abnormalities including placenta previa, or placental abruption. Bleeding and especially passing clots during pregnancy can be a sign of miscarriage, preterm labor, or other complications, so make sure to contact your healthcare provider if you experience bleeding. 

How to reduce your risk of blood clots in pregnancy

When it comes to DVT in pregnancy, prevention is key. In my own case, I was known to have a higher risk due to a thrombophilic disorder, as well as a history of previous clots. This meant that I was given an injectable low-molecular-weight Heparin (LMWH) drug (Fragmin coupons | Fragmin details) for the duration of my pregnancy as a preventative measure. 

There are also other preventative measures that can help lower your risk of clots, Dr. Segura says, including:

• Wearing compression stockings
• Keeping well-hydrated
• Staying active (“Regular exercise improves circulation,” Dr. Segura notes.) 
• Avoiding smoking
• Communicating any other medical conditions to your doctor

Blood clots are treatable, even during pregnancy; however, because of associated risks to you and your developing baby, getting diagnosed and treated as soon as possible is crucial.

Does Early Pregnancy Bleeding Mean a Miscarriage?

If you’re newly pregnant and start to notice vaginal bleeding, give yourself a moment to take a deep breath. Although bleeding may be a cause for alarm, it isn’t necessarily a sign of miscarriage—especially if it’s light.

Here’s a look at why bleeding or spotting may happen during different points in pregnancy. Always be sure to call your doctor to discuss your individual concerns.

Verywell / Jessica Olah

Bleeding During the First Trimester

First-trimester bleeding is more common than many people assume. Research varies, with some experts citing early-pregnancy bleeding in 15% to 25% of patients, and others reporting this figure to be as high as 40%.

Though an impending miscarriage is possible, it’s best not to jump to conclusions before discussing your symptoms with your doctor.

About 50% of women with first-trimester vaginal bleeding will miscarry, and 50% will not.

Possible Causes of Bleeding

Beyond miscarriage, possible causes of first-trimester bleeding or spotting include:

• Cervical sensitivity: A pelvic exam or sexual intercourse may cause your cervix to become tender and inflamed, leading to light, brown-tinged spotting that should resolve within a day or so.
• Implantation bleeding: Some women experience implantation bleeding as the lining of the uterus adjusts to the newly implanted egg.
• Infection: A urinary tract, cervical, or pelvic infection can cause vaginal bleeding.
• Molar pregnancy: Molar pregnancy is a rare form of gestational trophoblastic disease. In a molar pregnancy, a cluster of abnormal tissue develops in the uterus rather than an embryo, usually due to chromosomal problems during conception. Because molar pregnancies raise hCG levels, pregnancy tests still come back positive.
• Subchorionic hemorrhage: When blood accumulates between your uterine wall and the amniotic sac, a subchorionic hemorrhage or hematoma can cause early pregnancy bleeding. Subchorionic hemorrhage occurs in about 1% of pregnancies.

Cervical polyps and heavy exercise may also be responsible for spotting during early pregnancy.

Signs of Miscarriage

The highest risk of miscarriage is during the first 12 weeks of pregnancy. Vaginal bleeding that is bright red and gets heavier over time (rather than lighter) is more likely to indicate a miscarriage. Other signs of a miscarriage may include:

• Cramping: Lower abdominal cramping that’s worse than your typical menstrual cycle
• Discharge: Tissue, clots, or clumps in the blood
• Dizziness: Feeling lightheaded or faint

Ectopic Pregnancy

Less common than miscarriages, ectopic pregnancies can also produce vaginal bleeding. In an ectopic pregnancy, the fertilized egg implants itself somewhere other than the uterus, often in one of the fallopian tubes. Symptoms of ectopic pregnancy can be similar to miscarriage (including bleeding and cramping), you may notice a sharp or stabbing pain in your abdomen.

Second and Third Trimester Bleeding

In some cases, vaginal bleeding in the second or third trimester is not serious. Nonetheless, a dangerous condition must always be ruled out through an evaluation by your doctor.

See your doctor right away if you experience bleeding in your second or third trimester. Heavy or bright red blood that is accompanied by other symptoms like abdominal pain or contractions must be addressed immediately.

Light bleeding or spotting can happen later in pregnancy due to many of the same reasons as first trimester bleeding, such as slight irritation of the cervix after sexual intercourse, a medical exam, or growths on the cervix. Make an appointment with your doctor right away to pinpoint the cause and rule out a serious condition, such as:

Placental Abruption

A placental abruption occurs if all or some of the placenta suddenly separates from the uterus after week 20 of gestation. It’s an uncommon condition, occurring in about one out of every 100 pregnancies. It usually happens in the third trimester, and can trigger preterm delivery or stillbirth. You may feel contractions and abdominal pain along with the bleeding during a placental abruption.

Incompetent Cervix

This phenomenon happens in around one out of 100 pregnancies. An incompetent cervix is when the cervix starts to dilate too soon, which can result in miscarriage or pre-term birth. This complication is responsible for nearly 25% of miscarriages that occur in the second trimester.

Placenta Previa

This condition occurs when the placenta is low-lying and either somewhat or totally covers your cervix. Placenta previa can cause growth restrictions in the baby and fatal hemorrhaging (blood loss) in the mother, among other complications.

If you’re diagnosed with placenta previa, you will likely have to go on bed rest, often in a hospital. While serious, placenta previa is also rare, occurring in approximately one out of every 200 pregnancies.

Placenta Accreta

When the placenta grows too deeply into the uterine wall it cannot be released after the baby is born. This condition is called placenta accreta. It can become life-threatening if not found before delivery due to the risk of hemorrhage and late-pregnancy bleeding.

Placenta accreta is usually found during routine prenatal ultrasound. If you have placenta accreta, your doctor will plan for extra precautions during the delivery and possibly a hysterectomy (surgical removal of the uterus) once the baby is born.

Preterm Labor

Labor prior to the 37th week of pregnancy is considered preterm labor, the signs of which can be mistaken for bleeding. Often, before labor starts, you’ll pass the mucus plug, which can look bloody and watery (thus the common moniker, “bloody show”). The mucus plug may be passed several weeks before going into labor, or it could signal that preterm labor is about to occur.

Other symptoms of preterm labor may include cramping, abdominal pain or pressure, lower back pain or pressure, diarrhea, and contractions.

What to Do If You Notice Bleeding

If you experience bleeding or spotting any time during pregnancy, call your doctor and use a panty liner or pad to monitor it. Pay attention to the color: Is it pink, bright red, or brown? Note any activities you might have done in the past day or two that may be causing the bleeding, such as a pelvic exam, Pap smear, or sexual intercourse.

Never use a tampon during pregnancy or put anything in your vagina while you’re bleeding. Avoid sexual intercourse until your doctor gives you the all-clear.

A Word From Verywell

Vaginal bleeding during pregnancy can have lots of different causes—some serious and some not. It’s tough to know the difference on your own, so always call your doctor immediately if you experience bleeding during your pregnancy. Be sure to explain any other symptoms along with recent lifestyle cues to help decipher the cause.

Blood clots and pregnancy

A blood clot (also called a thrombosis) is a mass or clump of blood that forms when blood changes from a liquid to a solid. The body normally makes blood clots to stop the bleeding after a scrape or cut. But sometimes blood clots can partly or completely block the flow of blood in a blood vessel, like a vein or artery. 

Anyone can develop a blood clot, but you are at higher risk for a blood clot during pregnancy and up to 3 months after giving birth to your baby.  Most women with blood clotting conditions have healthy pregnancies. But these conditions may cause problems for some pregnant women. In severe cases, they can cause death for both mom and baby. But testing and treatment can help protect and save both you and your baby.

If you’re pregnant or trying to get pregnant and have had problems with blood clots in the past, tell your health care provider at a preconception checkup (before pregnancy) or at your first prenatal care checkup. 

If you or someone in your family like your parent, brother or sister has had problems with blood clots, talk to your provider.  Blood clots may run in your family.  You may also talk to your provider about getting a blood test to see if you have a thrombophilia. This is a health condition that increases your chances of making abnormal blood clots. Some pregnant women with thrombophilias need treatment with medicines called blood thinners. They stop clots from getting bigger and prevent new clots from forming.

Why are pregnant women at greater risk for blood clots?

Pregnant women are 5 times more likely to experience a blood clot compared to women who are not pregnant.  This may be because:

• When you’re pregnant, your blood clots more easily to lessen blood loss during labor and delivery.
• In pregnant women, the blood may flow less to the legs later in pregnancy because the growing baby presses upon blood vessels around your pelvis.  
• When you’re pregnant you may experience less movement or immobility (not moving a lot) like when you’re on bed rest or recovering from giving birth.

What are other reasons people may be at risk for having blood clots?

Certain things make you more likely than others to have a blood clot. These are called risk factors. Having a risk factor doesn’t mean for sure that you’ll have a blood clot. But it may increase your chances. Talk to your provider about what you can do to help reduce your risk.

Risk factors for blood clots include:

• Having certain health conditions, like a thrombophilia, high blood pressure, diabetes or being overweight or obese. A family history of blood clotting problems also increases your chances of blood clots. 
• Taking certain medicines, like birth control pills or estrogen hormones. These medicines can increase the risk of clotting. If you’ve had problems with blood clots or thrombophilias or have a family history of these conditions, birth control pills may not be safe for you to use. Talk to your provider about other birth control options.
• Smoking. Smoking damages the lining of blood vessels, which can cause blood clots to form.
• Having surgery, like a cesarean section (also called c-section). A c-section is a surgery in which your baby is born through a cut that your doctor makes in your belly and uterus. The American College of Obstetricians and Gynecologists (ACOG) recommends that doctors help prevent blood clots in women during a c-section. This may include using compression devices that put pressure on your legs to help keep your blood flowing during the c-section.
• Being dehydrated. This means you don’t have enough water in your body. Dehydration causes blood vessels to narrow and your blood to thicken, which makes you more likely to have blood clots.
• Not moving around much. This may be because you’re on bed rest during pregnancy or recovering from surgery or an accident. Being still for long periods of time can lead to poor blood flow, which makes you more likely to have blood clots. Even sitting for long periods of time, like when traveling by car or plane for 4 hours or more, can increase your chances of having a blood clot.
• Having a baby. You’re more likely to have a blood clot in the first 6 weeks after birth than women who haven’t given birth recently. 

What problems can blood clots cause during pregnancy?

If you have a blood clot or a kind of thrombophilia called antiphospholipid syndrome (also called APS), you may be more likely to have complications that can affect your health and your baby’s health, including:

Blood clots in the placenta. The placenta grows in your uterus (womb) and supplies the baby with food and oxygen through the umbilical cord. A blood clot in the placenta can stop blood flow to your baby and harm your baby. 

Heart attack. This usually happens when a blood clot blocks blood and oxygen flow to the heart. Without blood and oxygen, the heart can’t pump blood well, and the affected heart muscle can die. A heart attack can lead to lasting heart damage or death.

Intauterine growth restriction (also called IUGR). This is when your baby grows poorly in the womb.

Miscarriage. A miscarriage is when a baby dies in the womb before 20 weeks of pregnancy.

Placental insufficiency. This is when the placenta doesn’t work as well as it should so your baby gets less food and oxygen.

Preeclampsia. This condition that usually happens after the 20th week of pregnancy or right after pregnancy. It’s when a pregnant woman has both protein in her urine and high blood pressure. 

Premature birth. This is when your baby is born before 37 weeks of pregnancy.

Pulmonary embolism (also called PE). An embolism is a blood clot that moves from where it formed to another place in the body. When the clot moves to a lung, it’s a PE. PE can cause low oxygen levels in your blood and damage your body organs. It’s an emergency and a leading cause of death during pregnancy. Signs and symptoms of PE may include:

• Trouble breathing
• Fast or irregular heartbeat
• Chest pain
• Fainting
• Coughing up blood

Stillbirth. This is when a baby dies in the womb before birth but after 20 weeks of pregnancy.

Stroke. This happens when a blood clot blocks a blood vessel that brings blood to the brain, or when a blood vessel in the brain bursts open. Pregnancy and childbirth cause strokes in about 8 in 100,000 women. Stroke can cause lasting damage to the body or death.

Thrombosis. This happens when a blood clot forms in a blood vessel and blocks blood flow. It most often happens in the deep veins of the legs but can be in other places of the body: 

• Cerebral vein thrombosis (also called CVT). This happens when a blood clot forms in a vein in the brain. CVT can lead to stroke. Signs and symptoms include headache, vision problems and seizures.   
• Deep vein thrombosis (also called DVT). This happens when a blood clot forms in a vein deep in the body, usually in the lower leg or thigh. DVT can be diagnosed with ultrasound or other imaging tests. Signs and symptoms may include warmth and tenderness over the vein and pain, swelling or skin redness in the affected area.

Venous thromboembolism (also called VTE). This happens when a blood clot breaks off and travels through blood to vital organs, like the brain, lungs or heart. This condition includes DVT and PE. VTEs that block blood vessels in the brain or heart can cause stroke or heart attack.

How are these conditions treated?

Your provider may use tests like ultrasound or magnetic resonance imaging (also called MRI) to find out if you have a blot clot or clotting conditions. Ultrasound uses sound waves and a computer screen to make a picture of a baby in the womb. MRI uses magnets and computers to make a clear picture of the inside of the body. These tests are painless and safe for you and your baby.

If you’re pregnant and have a clotting condition, you may need to go for prenatal care checkups more often than women who don’t have these blood clot conditions. At these visits, your provider checks your blood pressure and can use other tests, like blood tests, to monitor your health. 

Your provider also checks your baby’s health in the womb using tests like:

• Ultrasound to check your baby’s growth and development. She may use a special kind of ultrasound called Doppler to check your baby’s blood flow in the umbilical artery, a blood vessel in the umbilical cord. The umbilical cord connects your baby to the placenta. It carries food and oxygen from the placenta to the baby. 
• Fetal heart rate monitoring (also called a nonstress test or NST). This test checks your baby’s heart rate in the womb and sees how the heart rate changes when your baby moves. Your provider uses this test to make sure your baby’s getting enough oxygen.

During pregnancy your provider may give you a blood thinner called heparin (low-molecular weight heparin or unfractionated heparin). If you have APS, your provider may instruct you to take heparin along with low-dose aspirin. Your provider also may refer you to a hematologist. This is a doctor who treats blood conditions.

After you give birth, your provider may continue to treat you with heparin. Or she may treat you with a blood thinner called warfarin. Warfarin is safe to take after pregnancy, even if you’re breastfeeding. Warfarin is not safe to take during pregnancy because it may cause birth defects.

Don’t take combined hormonal methods of birth control during the first 21-42 days after delivery.  The risk of DVT is highest in the first 21 days. 

How can I safely keep up with my prenatal care appointments during the COVID-19 pandemic?

During the coronavirus disease 2019 pandemic (COVID-19) your prenatal care visits may change. Ask your provider how he will monitor your health and do the tests you need while keeping you and your baby safe from COVID-19.

Providers are taking steps to prevent the spreading of COVID-19 by using telehealth or telemedicine. Telehealth or telemedicine are health visits where you talk to your provider by phone or by videocall, instead of going to his office.  You will need either a phone, tablet or computer for a telehealth visit and in some cases you may need access to the internet. Let your provider know if you are unable to have telehealth visits due to lack equipment or any other reason. Ask any questions you may have about keeping up with your ultrasounds and other tests while avoiding getting COVID-19.

What can I do to reduce my risk of blood clots?

• Know the signs and symptoms of a blood clot. On an affected limb like a leg or arm, you may notice swelling, pain or tenderness that was not caused by an injury, warm skin when you touch it or redness and discoloration.  Contact your provider if you experience any of these symptoms.
• Talk to your provider about your risk. If you or a family member like a parent, brother or sister have had blood clots before, tell your provider.  
• Move or stretch on long trips. If you sit for more than 4 hours on a trip, try to move your legs often. If you can walk around, you may do so.  If you can’t, you may try seated leg stretches like extending your legs straight out and moving your ankles to move your toes toward and away from you.  You may also pull your knee to your chest and hold it there with your hands for 15 seconds.  
• Follow other travel tips for reducing risk of blood clots. These include drinking lots of fluids like water, wearing loose-fitted clothing or wearing special stockings that compress your legs below the knee. Talk to your provider before trying these stockings.
• Follow your provider’s instructions during pregnancy and after giving birth. Your provider may give you medications like blood thinners or ask you to come in for additional prenatal care checkups.

More information

Last reviewed: February, 2020

90,000 Information about thrombosis during pregnancy

Increased risk of thrombosis

The risk of developing deep thrombosis of the legs and / or pelvic veins during pregnancy and childbirth is 5-6 times higher than in non-pregnant women. There are no precise statistics on the incidence of thrombosis, because objective diagnostic procedures, such as phlebography or fibrinogen tests, if used during pregnancy, with a big caveat.In addition, the clinical signs of thrombosis are not entirely reliable, and it is often difficult to distinguish between superficial thrombophlebitis and deep thrombosis.

The peak incidence of thrombosis in pregnant women occurs in the second trimester of pregnancy. The left leg is affected more often than the right. The reason for this is probably the pressure of the right iliac artery on the left iliac vein as it crosses.

Pathogenesis of thrombosis in pregnant women

Three pathogenic factors in the Virchow triad are also critical for the onset of thrombosis during pregnancy:

• changes in normal blood flow
• changes in blood composition
• state of blood vessels

Thrombosis during pregnancy may result from changes in normal blood flow in the lower extremities caused by obstruction of venous return blood flow by the growing uterus.

The risk of thrombosis increases due to corresponding changes in the blood coagulation system (hemostasis), since there is often a noticeable increase in the synthesis of plasma coagulation factors and platelets.

In particular, there may be a sharp increase in the level of fibrinogen to values ​​twice normal (from 400 to 650 mg / dL) in late pregnancy. In addition, factors in the fibrinolysis system are also reduced.

Deep vein thrombosis of the legs and pelvis observed after cesarean section is about three to eight percent in the absence of anticoagulant prophylaxis, that is, they are four to eight times more often than after vaginal delivery.The mortality rate from embolism is two to three percent, and thus 10 times higher than after spontaneous childbirth.

The cause may be a surgical trauma of blood vessels and tissues with an increased presence of thromboplastic material in the circulation. Patients who develop an infection of the peripheral vascular segments are at particular risk.

How to treat thrombophlebitis?

Thrombophlebitis is a superficial inflammation that occurs especially often along the long or short saphenous veins.Blood clots are usually small and separation is rare in deep veins due to the course of the veins and the anatomy of the valves. Treatment consists of local physical measures, namely the use of compression stockings, special compresses, as well as the patient’s physical activity. Compression therapy increases the efficiency of the muscle-venous pump in the legs and therefore the venous blood flow, thus preventing the progression of thrombosis.

Prevention

Epidemiologically confirmed risks associated with the onset of thrombosis during pregnancy and childbirth are:

• late pregnancy
• previous thromboembolic complications
• obesity
• smoking
• varicose veins
• cesarean section

history

women at particular risk of developing thromboembolic complications should register as early as possible.

In addition to physical (compression hosiery) and physical therapy prophylaxis, thrombosis prophylaxis with medication may be required, depending on how serious the risk is.

Low molecular weight heparin (eg Fragmin P or Fraxiparin) is often used because it is relatively simple and safe to use. These drugs are injected once a day using a syringe.

Hypercoagulation during pregnancy

A number of congenital and acquired diseases lead to a higher incidence of thromboembolic complications in everyday life, and even more so during pregnancy.

In addition to treating the underlying disease, especially careful physical and medical prevention of thrombosis is required during pregnancy.

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90,000 Thrombogenic risk factors in pregnant women.

If a woman has a history of cases of recurrent miscarriage or loss of a fetus in late pregnancy, toxicosis of the second

half of pregnancy, intrauterine fetal growth retardation, placental abruption or placental infarction, she is shown to be tested for thrombophilia.

Hyperhomocysteinemia, which sometimes develops under the influence of hereditary genetic polymorphism, is associated with late toxicosis and is involved in the development of heart attacks and placental abruption.Inflammation of the vascular endothelial lining with elevated homocysteine ​​levels causes an increased risk of both venous and arterial thrombosis. Hyperhomocysteinemia can be caused by the presence in the body of altered forms of the enzyme methylenetetrahydrofolate reductase (MTHFR), which is normally involved in the conversion of homocysteine ​​to methionine.

Hereditary Leiden (V) polymorphism, which has a strong predisposition to thrombosis, occurs with an increased frequency in women with recurrent miscarriage.

Among patients with recurrent miscarriage, abnormal forms of factor V Leiden are most common in women who have miscarriages in the second trimester of pregnancy.

Hyperhomocysteinemia by itself does not have a significant association with early fetal loss, suggesting that folate deficiency and MTHFR polymorphism may act through additional, as yet unknown factors. An increased level of homocysteine ​​is also detected in pregnancies complicated by preeclampsia, and this increase persists after childbirth.

Other causes of placental thrombosis.

Pregnancy can contribute to the manifestation of a genetic defect, as it develops the following features:

• Physiological increase in blood coagulation.
• Suppression of dissolution of fibrin clot (fibrinolysis).
• Decrease in the content and activity of natural blood anticoagulants.
• Increase in the functional activity of platelets.
• These changes during pregnancy have a protective value, they prevent profuse blood loss during childbirth, but at the same time they also provoke the development of thrombosis in the vessels of the placenta, especially in the presence of congenital pathology in the hemostatic system.
• Low vascular resistance of the placenta and slow blood flow in its vessels are key to ensuring good blood supply to the fetus, but it creates conditions for the deposition of fibrin and the formation of blood clots.
• Normal increases in fibrinogen and clotting proteins during pregnancy can also cause blood clots. A decrease in the availability of dietary folate occurs with smoking, and this can cause an even greater increase in homocysteine ​​levels.

The risk of thrombosis in inherited forms of thrombophilia can be reduced by using small doses of aspirin, heparin, folic acid, intravenous immunoglobulin G, or hematogenous factor concentrates. For carriers of inherited thrombophilia with recurring adverse pregnancy outcomes, two preventive treatment options deserve attention: the appointment of low molecular weight heparin (enoxaparin) to women with habitual late fetal loss and folic acid treatment for severe toxicosis in the second half of pregnancy.

In all individuals, pregnant and not, consumption of folic acid significantly reduces homocysteine ​​levels. The efficacy is high in cases where the homocysteine ​​level was highest before treatment and the lowest when the homocysteine ​​level was relatively low. A decrease in homocysteine ​​levels is observed when folic acid is used at a dose of 0.5 mg to 5 mg per day in combination with vitamin B6.

There is a high probability of thromboembolic complications in the presence of cardiovascular diseases, overweight, anemia, late toxicosis.The risk of thrombosis also increases in women in the age group after 40 years, in the presence of malignant tumors, a sedentary lifestyle. Prolonged, prolonged labor, cesarean section also predispose to complications. The group of very high risk for the development of thrombosis, including in the postpartum period, includes women with varicose veins of the lower extremities.

Causes of thrombosis

First of all, the development of postpartum thrombosis is associated with changes in the blood coagulation system.Blood is lost during a vaginal delivery or caesarean section. The amount of blood loss can be different – from minimal (physiological) to significant (pathological), depending on the specific situation. In any case, the body seeks to stop further blood flow, producing a large number of factors that contribute to an increase in blood coagulation through the formation of clots-plugs in the lumen of blood vessels. And the more blood loss, the more active these processes. In addition, when the placenta leaves or due to mechanical damage to tissues during the operation, the wall of the vessels is also damaged, special proteins and enzymes of the endothelium (the inner lining of the vessel) are released into the blood, which is also important for the shift of processes towards increasing blood coagulation.

To reduce the risk of venous thromboembolic complications during pregnancy, it is recommended to use low molecular weight heparins (LMWH) in prophylactic and intermediate doses in the form of subcutaneous injections. However, at present, the decision to prescribe LMWH to pregnant women is made only on the basis of a thrombotic history or upon detection of a particular thrombophilia (factor V Leiden mutations, prothrombin mutations, antithrombin deficiency, antiphospholipid antibodies, etc.).). These indications for the appointment of LMWH are subjective, since they are not based on accurate laboratory data measuring excessive (thrombotic) activation of blood coagulation at different stages of pregnancy. Accordingly, the use of these indications leads to an unreasonably widespread use of heparins during pregnancy.

The likelihood of blood clots during pregnancy is increased by congenital thrombophilia (a condition of increased blood clotting), caesarean section, mature maternity and overweight.If a woman has previously given birth three or more times or has multiple pregnancies (twins or more), the risk of thrombosis also increases. Additional risk factors for blood clots are: hypertension, cardiovascular disease and diabetes mellitus; the use of oral contraceptives before pregnancy; dehydration.

It is important to note that the risk of blood clots persists for two months after delivery.

Treatment of thrombosis is a complex process that must necessarily take place under the supervision of a physician.Therefore, in the presence of risk factors, thrombosis prophylaxis is recommended. Prophylaxis can be non-drug and medication. The doctor determines the degree of risk for each patient – low, moderate, high. After that, a prevention method is selected. As a rule, one non-drug prophylaxis for people with an increased risk of thrombosis is not enough, therefore, drug prophylaxis is carried out along with it. In this case, special drugs are used to prevent the formation of blood clots.

Antiphospholipid syndrome (APS) is the cause of many obstetric complications such as fetal loss syndrome, HELLP syndrome, and premature birth. The high risk of unfavorable obstetric outcomes in APS makes it necessary to plan pregnancy and select adequate therapy for a pregnant woman with this pathology.

Today, APS is one of the pressing problems in obstetric practice. Clinical manifestations of APS in obstetrics are fetal loss syndrome, intrauterine growth retardation, HELLP syndrome, oligohydramnios, feto-placental insufficiency, premature birth, preeclampsia (preeclampsia and eclampsia).Fetal loss syndrome is currently regarded as a specific marker of APS. Termination of pregnancy with APS can occur at any stage of pregnancy, and very often spontaneous miscarriage is the only symptom that allows the patient to suspect APS.

The high risk of unfavorable obstetric outcomes in APS dictates the need for pregnancy planning in these patients, careful selection of drug therapy and constant monitoring of the condition of the mother and fetus.

At the stage of planning pregnancy in a patient with APS, it is necessary to exclude concomitant risk factors for the development of thrombosis. The range of preventive measures includes correction of excess weight, treatment of concomitant arterial hypertension, correction of lipid spectrum disorders, smoking cessation, as well as the use of compression hosiery for post-thrombophlebitic syndrome.

From the moment of conception, pregnant women with APS are prescribed low doses of ASA (50-100 mg per day, but not more than 150 mg per day) and low molecular weight heparins until the moment of delivery.Low molecular weight heparins are canceled 12-24 hours before delivery. Heparin treatment is resumed 12 hours after delivery for a period of at least 4-6 weeks.

Timely diagnosis and adequate therapy of APS in pregnant women, careful monitoring of hemostasis system indicators, regular monitoring of the fetus, joint management of pregnancy by an obstetrician-gynecologist and related specialists can improve perinatal outcomes.

90,000 Varicose veins during pregnancy – what to do and how to treat

Veins are actively involved in the difficult 9-month pregnancy process, and their changes are significant.Even with full medical supervision, there is a risk of developing venous insufficiency.

Pregnancy is accompanied by profound changes in the entire female body. One of the first effects of pregnancy is an increase in the load on the veins of the pelvis and lower extremities. Therefore, many pregnant women develop varicose veins, which sometimes disappear after childbirth. This varicose vein lesion is accompanied by discomfort, a feeling of heaviness, pain when walking, however, women are mainly concerned about noticeable changes in the skin and varicose discoloration of the legs and ankles, which remain after pregnancy.

From malaise to illness

Many pregnant women are familiar with the feeling of malaise, accompanied by discomfort in the lower extremities. Functional chronic venous insufficiency is the first stage of venous disease with a feeling of heaviness in the lower extremities, sometimes with itching, paresthesias and, in some cases, convulsions, often nocturnal.

The possibility of thrombosis in pregnant women is 3-5 times higher than in other women. Sometimes blockage of veins leads to their inflammation – thrombophlebitis.The blood clots that form in the veins can cause a serious and dangerous disease – pulmonary embolism. In addition, the risk of developing thrombosis persists for another 1.5 months after childbirth, especially if they are severe.

Do I need to see a doctor?

There are five groups of factors affecting the body of a pregnant woman, which explain the need for observation by a phlebologist.

Mechanical factor

The enlarged uterus is an obstacle to blood circulation, as it compresses the inferior vena cava, pressing it against the spinal column and the iliac muscle.This is of particular importance at rest, when a sharp decrease in venous outflow can lead to postural shock, well known to gynecologists. The anatomical structure of the iliac vein, which crosses the right iliac artery, explains the high incidence of thrombosis in the left limb (Cocket’s syndrome).

Circulating factor

The increase in blood volume and blood outflow from the heart leads to an increase in the load on the vessels, especially the veins, and their expansion. This is especially important for the veins of the lower extremities and the vaginal area.

Hormonal factors

Progesterone, due to its relaxing effect on smooth muscle fibers, leads not only to a decrease in the tone of the venous wall, but also to a decrease in the tone of the urethra, bladder and small intestine.

Hemostatic factors

Changes in the hemostatic system always occur in the direction of increasing coagulability (increased levels of fibrinogen and factor III, increased platelet activity and decreased fibrinolytic activity).

Hemorheological factors

The viscosity of the blood rises despite the decrease in the hematocrit.

Other contributing factors

In addition to the above pregnancy-related factors, there are other contributing factors such as family history, sedentary lifestyle, standing still while working, driving a car, too low or high thin heels, obesity, underfloor heating, hot baths, and multiple pregnancies with short intervals between them.

How to prevent illness?

Pregnant women, regardless of risk factors and venous manifestations, always need lifestyle adjustments: avoiding standing still, sitting in a low chair, hot baths and sunbathing, adaptive exercises such as light walking, moving legs while sitting, contrast shower, elevated the position of the lower limbs in a state of rest.

And in any case, at the first signs of the disease (spider veins and dilated veins, in the later stages – swelling and pain), it is necessary to contact a phlebologist who can adequately assess the condition of the veins and prescribe the correct therapy.

Treatment of varicose veins in pregnant women – phlebology clinic “Institute of Veins”

Pregnancy and varicose veins. These two words are often used in one sentence – carrying a baby seriously increases the risk of bloating.

Varicose veins – an increase in blood vessels, which leads to impaired blood circulation. Most often, the disease affects the legs, but sometimes other parts of the body. The main symptoms are swelling, heaviness in the limbs, vascular patterns on the skin.His treatment is handled by a phlebologist.

A few months before giving birth, twice as much blood circulates in the body of the expectant mother than usual. The pressure in the vessels increases, which often leads to their expansion.

Another reason why such a field of medicine as phlebology is important for pregnant women is hormonal imbalance. Under the influence of hormones, the venous walls weaken. Add to this the increased loads and you get a serious likelihood of varicose veins.

Phlebologists from the Institute of Veni clinic will help protect against the appearance of spider veins and much more dangerous complications.

Do pregnant women often suffer from varicose veins

Studies have shown that varicose veins during pregnancy occur in 90% of young mothers. Moreover, with each new child, this risk only increases.

Do you think that if the first time this trouble passed you by, then everything is all right?

This is not the case.

The danger persists and continues to grow.

If during your first pregnancy you did not go to a phlebologist, then you must definitely do this when carrying a second child.Your doctor will explain in detail how to avoid unnecessary risks and keep you healthy.

It’s okay if, upon examination, the doctor diagnoses varicose veins. He will simply prescribe a treatment that is absolutely safe for you and there will be no more serious complications. The faster you do this, the better.

What to expect at different stages of varicose veins

The disease proceeds in several stages and each of them has special external signs.

1. First stage – subcutaneous vascular network is formed.After sitting or standing for a long time, the legs feel heavy.
2. Second stage – veins thicken and become visible on the skin surface. Sometimes nodules appear. Plus, the heaviness in the limbs increases and is often accompanied by edema.
3. Third stage – red and brown spots appear near the varicose veins. The edema becomes chronic. Sometimes they are complemented by convulsions.
4. Fourth stage – swelling increases and interferes with walking.Ulceration occurs on the skin.
5. Fifth stage – trophic ulcers are formed. The vessels become inflamed and blood clots appear in them.

But not only the stages of the disease are interesting, but also the forms of manifestation.

In what forms does varicose veins manifest in pregnant women

Although most of the cases occur on the legs, it can affect other organs as well. Its forms differ in external manifestations and the degree of threat to the body. For example, enlargement of the pelvic vessels often causes bleeding during childbirth.Therefore, you need to identify and eliminate these problems as quickly as possible.

Here are the symptoms of 6 main forms of varicose veins.

Varicose veins of the lower extremities

This is the most common form. It has the following symptoms:

Problems with the vessels of the small pelvis occur less often – mainly in women preparing to become mothers.

Varicose veins of the small pelvis

This form of the disease has 2 variants of the course: varicose veins of the vulva and perineum, as well as the syndrome of venous congestion.

Symptoms:

• feeling of heaviness and pain in the perineum,
• itching,
• pain when walking,
• increased fatigue,
• pronounced premenstrual syndrome,
• edema of the external genital organs.

Varicose veins can directly affect the genitals.

Varicose veins of the external genital organs

Consider the symptoms:

• severe vascular swelling,
• sensation of pain and discomfort in the genitals,
• puffiness,
• darkening of the skin.

Syndrome of venous congestion of the small pelvis

This is one of the options for the development of the disease. They have the same symptoms:

• itching,
• perineal pain,
• a sense of heaviness.

The syndrome of venous congestion is difficult to diagnose – it manifests itself in the same way as cystitis, colitis, inflammatory diseases of the uterus, and even similar to diseases of the hip joint. Only a doctor can accurately diagnose.

Right ovarian vein syndrome

The vein enlarges and compresses the right ureter. Because of this, the outflow of blood is disturbed.

Symptoms:

• severe attacks of pain in the right side of the abdomen,
• development of hydronephrosis and pyelonephritis is possible.

Ovarian varicose veins

Main symptoms:

• Gradual enlargement of the veins of the perineum, vagina,
• maximum vasodilation by the end of pregnancy.

We do not stop repeating, the sooner the doctor diagnoses you, the sooner he will relieve you of this problem.

This recommendation is also useful when vascular patterns appear on the skin.

What do spider veins mean during pregnancy

The most common manifestation of varicose veins when carrying a child is asterisks, cobwebs and other vascular patterns on the skin. They are easy to see, but not felt to the touch.

It is not difficult to understand that the formation of spider veins during pregnancy indicates vascular problems.

But don’t panic.

So far, the disease does not pose a danger to your son or daughter.

Consult a phlebologist. He will tell you how to treat spider veins during pregnancy.

We recommend reading about what causes varicose veins. Knowing the causes of spider veins in pregnant women, you will understand how to reduce the likelihood of complications.

What causes of varicose veins in pregnant women can be combated

All causes of this disease in pregnant women can be roughly divided into two groups.The first group includes factors that are beyond your control, the second – factors that you can influence. Let’s start with the first one.

Problems with veins inherited

A prerequisite for the occurrence of varicose veins is a genetic predisposition. Many people are simply born with weak vessel walls. Playing sports or carrying a baby almost always harms the circulatory system.

But this does not mean that you need to give up sports or the joys of motherhood.

Therefore, try to protect yourself from the influence of at least those factors that depend on you.And which you can easily adjust.

A few words about being overweight

Many people know that overweight people are at risk for varicose veins – they still have more stress on their legs. But not everyone is aware of the simple fact – during pregnancy, weight gain is inevitable due to a growing baby, an increase in the uterus, and amniotic fluid.

This cannot be completely avoided, as well as hormonal imbalance.

Consequences of the “hormonal storm”

In the body of expectant mothers, the volume of the hormone progesterone increases.It is necessary for the development of the fetus, but at the same time weakens the walls of blood vessels. Their elasticity decreases and with increasing pressure they expand. This happens especially often when the blood volume increases.

Why a lot of blood is not always good

In the circulatory system of women before childbirth, twice as much blood circulates than before pregnancy. Even in the second trimester, its amount significantly exceeds the usual rates. The circulatory system is exposed to great stress.Combined with hormonal imbalances, this almost guarantees bloating of the veins. The situation is aggravated by the enlargement of the uterus.

How the volume of the uterus affects the veins

With the development of the fetus, the uterus enlarges and the vessels of the small pelvis are compressed. The outflow of blood from the extremities worsens, and the load on the venous walls increases – as a result, varicose veins occur. Increased blood clotting speeds up its appearance.

Protection for a child, a threat to blood vessels

Strengthening blood clotting is a protective reaction of the body to childbirth.It prevents blood loss when the placenta is separated.

While generally a useful defense mechanism, it can wreak havoc on the circulatory system. Thick blood increases the risk of venous dilatation and blood clots. This is especially dangerous if the pregnant woman is predominantly sedentary.

The less movement, the weaker the vessels

As the fetus grows, many expectant mothers change their lifestyle – they spend more time sitting or lying down.They walk less, which is why muscle activity decreases and blood stagnation occurs.

This factor in the development of varicose veins is the only one that pregnant women can independently influence. Next, we will tell you how to determine if you are at risk for blood clots or not.

Who is at risk of thrombosis during pregnancy

In pregnant women, blood clots form ten times more often than in non-pregnant women. Moreover, 20% of all maternal deaths are associated precisely with thrombosis – a blockage of blood vessels that prevents blood flow.

Women are at risk:

• Over 35 years old.
• Not giving birth to their first child.
• Weighing more than 80 kg.
• Who have relatives with thrombosis.
• With varicose veins.
• With thrombophilia.
• By which a caesarean section was performed.

Next, we will show the depth of the problem and tell you what to do.

Why is it difficult to treat venous complications during pregnancy

Getting rid of thrombosis while carrying a baby is not easy for several reasons:

• Only certain periods of pregnancy are suitable for treatment: 7-8, 13-17 and 23-27 weeks.
• There is a high likelihood of complications and an interruption may be required.
• It is difficult to find the correct dosage of the anticoagulant.

To avoid these problems, we recommend that you be attentive to your health and engage in the prevention of varicose veins.

How important is the prevention of varicose veins during pregnancy

Complications of varicose veins are very dangerous and can be fatal. Timely prevention and treatment will protect you from such consequences.

For those who are at risk or want to protect themselves, we have prepared two lists. One contains useful recommendations, and the other describes the factors that accelerate the progression of the disease.

9 best measures to prevent varicose veins during pregnancy

1. Sleep on your left side. In this position, the uterus will not interfere with the outflow of blood.
2. Go swimming and take a contrast shower.
3. Get enough sleep at night and rest during the day.
4. Walk for at least 2 hours every day.
5. Alternate between resting and walking to distribute the load on the body.
6. Eat more fiber and vegetable fats. This will strengthen the venous walls.
7. Do exercise for prevention.
8. Add more vegetables and fruits to your daily diet.
9. Wear specially selected compression garments.

And we also want to offer a list of things that you do not need to do if you seriously decided to defeat varicose veins.

What will accelerate the development of the disease

• Tight clothing – this will impair blood circulation.
• Shoes with high heels – it increases the load on the circulatory system.
• Tights, socks with tight elastic bands – they impair the outflow of blood.
• Throwing one leg over the other – in this position, blood circulation is disturbed.
• Saunas and baths – due to high temperatures, the load on the venous walls increases.

But all these recommendations will be ineffective if the disease has already gone too far.In this case, we recommend that you familiarize yourself with modern methods of eliminating it.

We offer 4 methods for the treatment of varicose veins

Surgical treatment of varicose veins in pregnant women is an extreme measure, it is prescribed only in case of a serious threat to life.

Therefore, we recommend that you think about contacting a phlebologist before you decide to become a mother. To restore health, one of four modern methods is suitable. Doctors prescribe them at different stages of the disease.

Microsclerotherapy

Sclerotherapy during pregnancy is not prescribed. The procedure serves to eliminate cosmetic defects. For 1 session, we remove up to 98% of manifestations.

During the operation, a sclerosant is injected into the damaged area, gluing the walls. After this, the manifestations are invisible on the skin. The procedure leaves no residue and does not require restoration.

Endovasal laser coagulation

The procedure is prescribed for venous dilatation up to 10 mm.It allows you to remove and swelling, and vascular neoplasms, and trophic ulcers.

The operation is carried out no more than 40 minutes, without anesthesia and scars. Patients usually start work the next day.

Foam sclerotherapy

The procedure removes varicose veins, relieves swelling of the central and peripheral vessels. With the help of foam sclerotherapy, sick veins with a diameter of more than 10 mm are treated.

The operation takes up to 20 minutes. There are no scars left after it.Anesthesia is not used, but even patients with hypersensitivity do not experience pain during treatment.

Miniflebectomy

This technique helps to restore veins with a diameter of 10-18 mm. It removes swelling of the legs, normalizes blood outflow.

The doctor completes the procedure in just 1 hour. You can walk immediately after the operation, and it takes no more than 10 days to fully recover. Instead of scars, only small bruises remain on the skin, which dissolve in 2 weeks.

The doctors of the Vein Institute will heal you without pain, scars and anesthesia.Taking care of your situation.

The most experienced phlebologists from Kiev and Kharkov work in our clinic. For 15 years, they have successfully operated over 4,000 people, and our army of grateful patients is replenished every day.

Our doctors are engaged not only in medical, but also in research work. Rustem Osmanov and Oksana Ryabinskaya are published in scientific journals. For two, they wrote over 100 articles. They hold patents for inventions in the field of phlebology.

They speak at world phlebological forums.Oksana Ryabinskaya took part in a conference in Melbourne in February 2018. In August 2019, she gave a presentation in Krakow.

Surgeon of the highest category, phlebologist

Experience: 21 years

Surgeon of the highest category, phlebologist

Experience: 20 years

Phlebologist of the highest category

Work experience: 34 years

Dermatologist higher.cat., director

Experience: 20 years

First category surgeon

Work experience: 15 years

Surgeon, phlebologist

Work experience: 17 years

Surgeon, phlebologist

Work experience: 5 years

First category surgeon

Experience: 12 years

Vascular surgeon, phlebologist

Experience: 10 years

Vascular surgeon, chief physician

Work experience: 11 years

Vascular surgeon, phlebologist

Work experience: 8 years

Vascular surgeon, phlebologist

Work experience: 5 years

Want to know more? – You just need to ask a question to the phlebologist

After reading this article, you most likely still have questions about how to avoid or get rid of varicose veins.Call the department of our clinic in Kiev or Kharkov. They will call you back in a maximum of half an hour and answer your questions in detail.

Some of our patients are uncomfortable talking about their symptoms over the phone. In this case, use the question form. To ask a question to a phlebologist, enter your name, email and phone number. Our doctors will be happy to answer you.

90,000 Varicose veins during pregnancy. Phlebologist’s recommendations for pregnant women

Chronic venous insufficiency and pregnancy

Pregnancy is a wonderful, joyful and natural state.However, pregnancy does not always go smoothly. Hormonal changes in this period of life have a positive effect on the woman’s body, protect it in this difficult period, but the same hormones can significantly complicate the work of other organs and systems. Connective tissue undergoes the greatest changes. This can cause various problems: pain in the lower back and joints, the appearance of “stretch marks” on the skin of the chest and abdomen, flat feet. In addition, 50% of women develop either dilated skin capillaries or varicose veins during their first pregnancy.With repeated pregnancies, this percentage increases, and the risk of thrombotic complications also sharply increases.

Nature made sure that during childbirth the mother did not lose a lot of blood. For this, during pregnancy, under the influence of hormones, the blood becomes thicker. Thickening of blood, as well as venous congestion, significantly increase the risk of blood clots in the veins. In the expectant mother, this risk is 3-5 times higher than in the non-pregnant one. The formation of blood clots in the veins can cause a serious and sometimes fatal complication – pulmonary embolism, which threatens not only the health, but also the life of the mother and the unborn child.The risk of thrombosis remains high and is even especially dangerous for 6 weeks after childbirth, especially after a cesarean section or large blood loss during childbirth. Thus, pregnancy is actually a thrombogenic condition. This means that the normal changes that occur in the body during a physiological pregnancy increase the likelihood of deep vein thrombosis.

These changes are as follows:


• Significant slowing down of blood flow in the deep veins of the legs due to increased outflow of blood from the placental uterus with overload of the iliac veins;
• Decrease in the tone of the walls of the veins and their physiological expansion, which leads to natural valvular insufficiency and reverse blood flow;
• Increased pressure in the veins of the lower extremities by 2-3 times;
• Increased production of sex hormones, progesterone and relaxin, which directly affect elastic fibers and reduce vascular smooth muscle tone;
• Significant increase in the concentration of blood coagulation factors;
• Decreased fibrinolytic (dissolution of clots or blood clots) blood capacity at the end of pregnancy and in the first stage of labor;
• Entering the blood of active substances after placenta separation

Difficulty in venous outflow from the lower extremities during pregnancy is due to a cascade of five mechanisms:


– Mechanical factor. The enlarged uterus is an obstacle to circulation, as it compresses the inferior vena cava, pressing it against the spine and iliac muscle.

– Circulatory factor. An increase in blood volume and outflow of blood from the heart leads to an increase in the load on the veins and their expansion. This is especially important for the veins of the lower extremities and the vaginal area.

– Hormonal factors. Progesterone, due to its relaxing effect on smooth muscle fibers, leads not only to a decrease in the tone of the venous wall, but also to a decrease in the tone of the urethra, bladder and small intestine.

– Hemostatic factors. Changes in the hemostatic system always occur in the direction of increased coagulability (increased fibrinogen levels, increased platelet activity and decreased fibrinolytic activity).

– Hemorheological factors. Blood viscosity increases despite a decrease in hematocrit

– Other contributing factors. These factors include a family history, a sedentary lifestyle, prolonged immobility while working, driving a car, heels that are too high or too thin, obesity, hot baths, multiple pregnancies or short intervals between pregnancies.

The danger increases from the 5th month of the first pregnancy, significantly increases with each subsequent one. The triggering factor is hormonal changes occurring in the body of a pregnant woman: the release of large quantities of female sex hormones, in particular, the hormones of the corpus luteum. In addition, the pregnant uterus grows and, gradually, more and more squeezes the large veins located in the small pelvis and abdominal cavity, creating obstacles for the outflow of venous blood from the lower extremities.The result is stagnation of venous blood and an increase in pressure in the veins of the legs and small pelvis.

During pregnancy, a woman’s body undergoes many changes. The hormone progesterone, which is responsible for the preservation and development of the fetus, affects not only the uterus, but also the veins, their smooth muscle cells, due to which their tone decreases. The effect of progesterone begins from the first days of conception and fetal development. A high level of the hormone leads to the development of degenerative changes in elastic and collagen fibers, as a result of which the veins become less elastic and dilate.The process proceeds more quickly if the hormonal background was disturbed even before pregnancy, as well as if the woman was taking hormonal drugs, oral contraceptives.

The development of varicose veins during pregnancy occurs as a result of many factors. An increase in the volume of circulating blood leads to an increase in pressure on the vessels. Because of this, the veins suffer, since their wall has a lower density and elasticity in comparison with the arteries.

The increase in the size of the uterus puts pressure on the veins of the small pelvis, which leads to a delay in the outflow of blood from the legs to the upper region.For this reason, varicose veins of the lower extremities occur. An increase in pressure on the vessels of the lower extremities due to the constant weight gain of a pregnant woman. The saphenous veins, which are not surrounded by muscles, are most affected compared to the deep veins. They most often undergo varicose veins, since their wall is not surrounded by the outer layer of the muscular frame.

There are such forms of varicose veins in pregnant women:


• Varicose veins of the lower extremities
• Varicose veins of the small pelvis
• Varicose veins of the external genital organs
• Syndrome of venous congestion of the small pelvis
• Right ovarian vein syndrome
• Varicose ovarian veins (varicoovarium)

Currently, there are 2 variants of the course of varicose veins of the small pelvis: varicose veins of the perineum and vulva, as well as the syndrome of pelvic venous congestion.It should be emphasized that this division is rather arbitrary, since in more than 50% of cases, varicose veins of the perineum and vulva provoke a violation of the outflow from the small pelvis, and vice versa.

Varicose veins of the perineum and vulva


It is noted in 30% of women during pregnancy. The mechanisms of this condition are basically similar to those in varicose veins of the lower extremities. At the same time, the progressive varicose transformation of the perineal veins is aggravated by the compression by the pregnant uterus of the main veins of the retroperitoneal space (iliac and inferior vena cava).Outside of pregnancy persists in 2-10% of cases.

Pelvic Congestion Syndrome

A variety of clinical manifestations and imperfect diagnostics mask it under various forms of gynecological (inflammatory diseases of the uterus and its appendages, endometriosis), urological (cystitis), surgical (colitis, Crohn’s disease and others) and even orthopedic (diseases of the hip joint) pathology.

This disease is associated with varicose veins of the ovaries and the wide ligament of the uterus.The main mechanism is valve insufficiency of the ovarian veins, leading to a discharge of blood and an increase in pressure in the venous plexuses of the small pelvis. Predisposing factors can be retroflection of the uterus, leading to the bending of the wide ligament of the uterus, which impedes the outflow of venous blood, as well as various gynecological diseases (endometriosis, tumors of the uterus and ovaries). In recent years, the adverse effects of hormonal therapy and contraception have been discussed. The influence of the hormonal background is evidenced by the fact that the manifestations of the syndrome of venous congestion of the small pelvis in the postmenopausal period become less pronounced.

The clinical picture of the disease is quite characteristic and is manifested by the progressive varicose veins of the perineum, vulva, vagina, and lower extremities (cosmetic defect), progressive as the gestation period increases. Signs of such violations will be:

• Itching in the area of ​​varicose veins.
• Feeling of heaviness and bursting pain in the perineum, small pelvis, edema of the external genitalia, lower extremities.
• Dyspareunia (pain during intercourse)
• Dysmenorrhea
• Severe premenstrual syndrome
• Pain when walking and exercising
• Pain along the veins
• General pain and leg aches
• Dysuric disorders.
• Fatigue.
• Development of acute varicothrombophlebitis and rupture of altered veins, which is accompanied by massive bleeding.

Thrombosis during pregnancy is a major clinical problem. This is due to the high frequency of this condition as a cause of maternal mortality (20% of all causes). As you know, during pregnancy there is a tenfold increase in the risk of thrombosis. The incidence of thrombosis is 0.7 – 4.2 / 1000 in pregnant women versus 1/10 000 in non-pregnant women of childbearing age.

A critical stage of the thrombotic process is pulmonary embolism – the most severe and very often fatal complication of thrombosis. PE is the leading cause of maternal mortality in obstetric practice in the West – 0.7 cases per 1000 births (from 11% to 27%). The likelihood of venous thromboebolic complications (VTO) during cesarean section is 3-6 times higher. The risk of developing VTE returns to levels seen in non-pregnant women 6 weeks after delivery.

The main risk factors for WTO include the following:


• Age (> 35 years old)
• Caesarean section
• Weight> 80 kg
• Individual and family history of thrombosis
• Rebirth
• Ovarian hyperstimulation
• Prolonged immobilization
• Varicose veins
• Thrombophilia

The complexity of the treatment of OBE during pregnancy is as follows:


• Direct dependence on gestational age (safe periods of pregnancy for active treatment tactics 7-8 weeks, 13-17 weeks, 23-27 weeks)
• Difficulty in selecting the type and dosage of anticoagulant
• High probability of termination of pregnancy and (or) development of complications
• The need to resolve a complex issue on the choice of treatment tactics
• Ethical issue of life preservation choice
• The problem of achieving compliance with the patient and her relatives

As for varicose veins of the lower extremities during pregnancy, this problem is very extensive and ambiguous.Patients with varicose veins who are planning a pregnancy should clearly understand the risks, adequately assess the danger posed by the disease not only to the mother, but also to the unborn child, so as not to then impose all responsibility on doctors, who in this case will have very limited capabilities. This responsibility, first of all, should lie with the parents of the unborn child. Experts always insist that varicose veins be cured before pregnancy, then there will be no corresponding risk.

On the one hand, the presence of varicose veins is the main risk factor for VTO, i.e. there is a strong need for the prevention of such complications – for surgical treatment. On the other hand, during pregnancy, the possibilities of surgical treatment are sharply limited by the safe periods of pregnancy. And if before pregnancy the patient has a fairly large choice in treatment methods, then in the event of complications of varicose veins during pregnancy, for example thrombophlebitis, only a standard operation will be a possible method of removing veins, and this is general anesthesia and the need to prescribe medications, which is a direct threat to the fetus. and in addition, a pronounced surgical trauma, causing certain changes in the body, clearly not going to the benefit of the pregnant woman and the fetus.A clear advantage in this case will have modern low-traumatic methods of surgical treatment – EVLO and RFO, because they do not require the use of general anesthesia and the appointment of a significant amount of medications, and also do not cause severe surgical trauma and are safe. However, in this case, given the constant growth of the pregnant uterus and progressive changes in the venous circulation with a sharp increase in pressure in the veins, the likelihood of a relapse of the disease is very high.Certain conditions and technical possibilities for performing such an intervention will also be an important factor.

Therefore, if a patient with varicose veins seeks help already during pregnancy, in most cases conservative methods of prevention are still prescribed, as a rule – compression therapy, taking phlebotropic drugs in safe periods of pregnancy, dynamic observation with an objective assessment of the condition. In the absence of complications during pregnancy, surgical treatment is prescribed after the period of breastfeeding.However, the high risk of VTO in case of varicose veins in pregnant women, even with compression therapy, remains, especially in the presence of several risk factors, which we mentioned above.

For example, the standard for the prevention of WTO in Europe in the presence of several risk factors for thrombosis, in the presence of varicose veins, is the appointment of daily injections of drugs that “thin” the blood for the entire period of pregnancy! Is it really worth it not to operate on your varicose veins before pregnancy, using modern methods, quickly, painlessly, and then be absolutely calm for yourself and your unborn child ?!

So, the main measure for preventing the development of VTO in the presence of varicose veins is timely and adequate treatment (timely surgical treatment, compliance with the compression therapy regimen, correction of the rheological properties of blood and blood coagulation processes, an active lifestyle).

The main simple preventive measures are as follows:


• Wear comfortable underwear;
• Limit physical activity, while doing simple exercises to keep fit, swimming
• Monitor nutrition by introducing more fiber into the diet
• Sufficient liquid
• Walking in loose shoes, heel no more than 4 cm, comfortable, not tight clothing
• Do not take hot baths, do not visit the bathhouse, sauna
• Daily rising contrast shower
• Active motor mode, avoid long stationary positions, walking 2 h / d
• Perform Special Venous Gymnastics
• Keep track of weight
• Sleep on the left side
• Wear compression hosiery
• Observe a phlebologist

Considering all of the above, our advice to pregnant women with varicose veins:


• Wear compression hosiery at all times throughout your pregnancy;
• Observe an active motor mode;
• be observed by a phlebologist throughout pregnancy;
• strictly follow all the recommendations of a specialist;
• At the first sign of deterioration, seek help immediately.

If you are planning a pregnancy and you have varicose veins, operate them before pregnancy and protect yourself and your unborn child.




The article was prepared by a vascular surgeon of the highest category, phlebologist Gerasimov Vladimir Vladimirovich .


To receive information about treatment and make an appointment, call the Dobrobut MS Contact Center:

044 495 2 888 or 097 495 2 888


Phlebologist’s consultation
Prevention of varicose veins

Pregnancy and risks of thrombosis: recommendations of a hemostasiologist

An analysis for markers of hereditary thrombophilia is now being taken by all patients of antenatal clinics.About why during pregnancy the likelihood of thrombosis and other pathologies associated with blood clotting disorders increases, why, when detecting markers, it is necessary to take timely measures, specialist of the advisory hemostasiological team of the Moscow GBUZ “GKB No. 52 DZM”, a doctor, told the med-info.ru portal anesthesiologist-resuscitator Simarova Irina Borisovna .

Thank you for the material provided portal med-info.ru

Why are there increased risks of thrombosis during pregnancy?

During pregnancy, there is a natural increase in the activity of the blood coagulating system.Therefore, in women at risk, pregnancy contributes to pathological thrombosis.

According to international studies, the likelihood of blood clots during pregnancy and in the first months of childbirth increases 5-10 times. Pregnancy can provoke disturbances of microcirculation in the fetoplacental complex, and the occurrence of other hematological diseases, as a result of which not only thrombotic, but also obstetric complications are possible.

In order to minimize the risks, a thorough history taking and special blood tests are needed, which are prescribed in the antenatal clinic.

What are the main risk factors?

There are actually many factors that increase the risks: among them age over 35 years, obesity, complications of the course of previous pregnancies, infections, smoking, varicose veins and even long flights. As a rule, a set of factors “works”, but in most cases this occurs against the background of a hereditary predisposition. And if earlier the doctor carefully asked the patient about the presence of thrombosis in relatives, now for all pregnant women an analysis is required for a marker of hereditary thrombophilia.

What to do if a marker of hereditary thrombophilia is identified?

The presence of a hereditary tendency to thrombophilia means the need for prevention, treatment and management of pregnancy, taking into account the existing risks. There are different types of thrombophilia and different degrees of risk of thrombogenicity. A hematologist can determine this and prescribe treatment, to which the patient should be referred by a gynecologist. The presence of consulting hematological services is a great help to people with disorders of blood clotting factors and with a hereditary tendency to them.The number of such specialists is growing in the outpatient department, but it may take some time to see them. But if pregnancy has come, it is better not to hesitate, contacting the consultation and diagnostic centers at hospitals, in particular, at the Moscow City Clinical Hospital No. 52.

The main advice is to get into the hands of specialists in time who understand this pathology and will be able to accompany pregnancy and the postpartum period. Doctors have at their disposal all the most modern diagnostic and therapeutic techniques.

Can the problem be considered solved after a successful delivery?

Risks remain in the postpartum period. In addition, knowing your problems, it is very important to follow the recommendations and periodically undergo examinations. Long-term observation may also be necessary. At discharge, the doctor will definitely give recommendations and, most likely, will invite you to come for a consultation after a while.

But there is a problem: not all women follow the recommendations and come for a second examination.I’d like to remind dear patients that doctors can do a lot, but your health is, first of all, your responsibility. Searching for good specialists, constant contact with a doctor, if necessary, adherence to all recommendations is a guarantee that you will not face serious problems.

Where will they help?

The obstetric and gynecological service of GBUZ “GKB No. 52 DZM” specializes in the management of pregnancy and childbirth in patients with a high risk of thrombogenicity.

With a referral from the antenatal clinic in which the patient is being observed, you should contact the antenatal consultation office at the maternity hospital GKB No. 52 (8 (915) 179-90-05 from 8:00 to 15:30 on weekdays), from where, if necessary, the doctor will send for hospitalization in the pregnancy pathology department of the maternity hospital №52.Also, a consultation with a hemostasiologist at City Clinical Hospital No. 52 can be obtained in the paid services department (8 (499) 196-09-24 from 09:00 to 21:00 daily).

90,000 Are you pregnant and planning to travel by plane? Take note of these recommendations

Did you find out that you are pregnant and you are planning a flight to a warmer region? No problems! You can fly during pregnancy, but there are some restrictions in this regard.

As a rule, flights do not pose a particular risk to a pregnant woman and the baby she is expecting.However, it is not recommended to fly long distances in the last trimester, i.e. from week 36. Shorter flights are permissible for another two weeks after that, that is, up to 38 weeks, provided that the pregnancy is proceeding without complications. With multiple and difficult pregnancies, the restrictions are more stringent.

In advance of the flight, you should check the airline’s practice with regard to pregnant women, as rules may differ from airline to airline.

Finnair will allow you to board the aircraft until the end of your 36th week of pregnancy. At a later date, short flights within Finland and Scandinavia are allowed up to 38 weeks, provided that the pregnancy is proceeding without complications. Finnair requires a doctor’s certificate that the pregnancy is normal if the pregnancy is 28 full weeks or more. The completed application form is on the airline’s website, and it must be provided before the trip.

In order to avoid possible delays, some airlines recommend taking with you a doctor’s certificate in English about your well-being already in the early stages and in the middle of pregnancy.The strict restrictions come from safety reasons: the airline does not want a pregnant woman on board to become a cause for unnecessary anxiety.

Restrictions are caused by the risk of premature birth, as the conditions for childbirth and childbirth on board are very poor.

– If you fly at a later date, it can provoke childbirth, since the uterus is large and sometimes to some extent also in good shape, says obstetrician-gynecologist Mika Nuutila .

Pregnant women are advised to check what the travel insurance policy says about pregnancy.

Increased risk of blood clots

The greatest risk of flight is not for the baby in the womb, but for the pregnant woman. Pregnancy itself increases blood clotting, and prolonged sitting position increases the risk of blood clot formation by 6-10 times.