Blood clots are a serious concern following any major surgery, including a C-section. A blood clot is a clump of blood that changes from a liquid to a semi-solid state. While clotting is necessary to stop bleeding, a clot forming inappropriately within a vein is known as venous thromboembolism (VTE) and can be dangerous. Though the overall chance of this complication is low, new mothers need to understand this risk for a safe postpartum recovery. This article covers the elevated risk after a C-section, the signs requiring immediate action, and steps for prevention.
Understanding the Increased Risk After C-Section
The body naturally changes during pregnancy to prepare for delivery, which increases the likelihood of blood clot formation. These changes, combined with the surgical nature of a C-section, elevate the risk of developing VTE compared to a vaginal delivery. The risk is highest during the six weeks following childbirth.
Virchow’s Triad
This heightened risk is explained by three main factors known as Virchow’s Triad: vessel injury, altered blood flow, and hypercoagulability. The C-section causes direct injury to blood vessels in the pelvis and abdomen, triggering the body’s clotting response. Pressure from the growing uterus slows blood flow, causing blood to pool (venous stasis). Hormonal changes also make the blood “stickier,” a state called hypercoagulability, which protects against excessive bleeding during delivery.
A clot that forms in a deep vein, most often in the leg or pelvis, is called a Deep Vein Thrombosis (DVT). If a DVT breaks loose and travels to the lungs, it becomes a life-threatening complication known as a Pulmonary Embolism (PE).
Identifying Critical Symptoms
Knowing the specific signs of VTE is necessary to seek immediate help.
Deep Vein Thrombosis (DVT) Symptoms
DVT symptoms typically affect one leg, often the calf or thigh. Signs include swelling that is noticeably larger in one leg than the other. The affected area may also feel warm and appear red or discolored. A persistent pain or tenderness in the limb, which often feels like a severe cramp or a pulled muscle, is a common sign. This pain does not improve with rest or elevation and should prompt a call to a healthcare provider.
Pulmonary Embolism (PE) Symptoms
Symptoms of a Pulmonary Embolism are severe and demand immediate emergency attention. A sudden onset of shortness of breath unexplained by physical exertion is a major warning sign. This may be accompanied by sharp chest pain that intensifies when taking a deep breath or coughing. Other signs include a rapid heart rate, lightheadedness, or feeling faint. An unexplained cough, which sometimes produces blood, is also a symptom of a PE. Any combination of these symptoms requires calling emergency services immediately.
Prevention and Emergency Protocols
Early and frequent ambulation, or walking, after surgery is the most effective action a patient can take to prevent VTE. Moving the legs helps to increase blood flow and prevents venous stasis, mitigating the risk factor of immobility. Getting out of bed and walking short distances as soon as medically permitted is encouraged, even if it is uncomfortable at first.
Maintaining adequate hydration is also important, as dehydration can cause the blood to become thicker and more prone to clotting. If a patient is considered high-risk (due to factors like obesity, pre-existing conditions, or an emergency C-section), a doctor may prescribe prophylactic medication. This typically involves a short course of a blood thinner, such as low-molecular-weight heparin, administered via injection after delivery.
When to Seek Help
Patients should have a clear protocol for seeking medical assistance based on the severity of their symptoms. For isolated DVT symptoms, such as unilateral leg pain or swelling without signs of respiratory distress, the patient should call their healthcare provider or obstetrician right away. The provider can then arrange for necessary diagnostic testing, like an ultrasound of the leg.
For any signs of a Pulmonary Embolism (sudden difficulty breathing, chest pain, or rapid heart rate), the patient should immediately call 911 or their local emergency services. These symptoms indicate a life-threatening emergency requiring urgent intervention. If VTE is diagnosed, treatment usually involves an extended course of anticoagulant medication, often for six weeks or longer after delivery.