Postpartum thrombophlebitis

Postpartum thrombophlebitis can occur in the superficial veins of the extremities, uterine veins, pelvic veins or deep veins of the lower limbs. Thrombophlebitis of superficial veins of the lower extremities usually take place against a background of varicose veins.

Symptoms, course. Inflamed veins are strained, painful on palpation, skin over the affected area is hyperemic, subfebrile, small tachycardia. Thrombophlebitis of the uterine veins is characterized by symptoms of the subinvolution of the uterus, prolonged bloody discharge from the vagina, an increase in temperature, an increase in heart rate. When vaginal examination can be found convoluted cords (veins) on the surface of the uterus. Thrombophlebitis of the veins of the pelvis (metrotrombophlebitis) develops at the end of the 1st week after childbirth, accompanied by high fever, increased heart rate, chills in poor general condition. With vaginal examination on the side walls of the small pelvis, crimped and painful veins are determined. Palpation should be very careful because of the risk of separation of the clot! Thrombophlebitis of the deep veins of the lower extremities occurs at the second week of the postpartum period. The onset of the disease is acute, accompanied by pain in the leg, the appearance of edema, fever, chills, and the pulse rate is significantly increased (more than 120 in 1 min). At objective research the smoothness of the inguinal fold of the affected limb is found: palpation in the region of the femoral (Scarpian) triangle with thrombophlebitis of the deep veins of the thigh is painful. There is also soreness in the course of the large vascular trunks of the thigh and lower leg. Duration of the disease up to 6-8 weeks.

Treatment. Bed rest, with thrombophlebitis of the lower limbs elevated position of the legs; Antibiotics, sulfonamides, drugs with anti-inflammatory properties (escuzane, butadione, acetylsalicylic acid). Treatment with anticoagulants can not be started before the 3rd day after childbirth (risk of uterine bleeding). Assign Heparin under the control of blood clotting indicators, anticoagulants of indirect action under the control of the prothrombin index (its value should not be less than 40-50%). Apply promedol, papaverine, novocaine in the candle.

In case of acute thrombosis of the veins of the lower limbs, intravenous injection of fibrinolysin or streptokinase (streptodecase) and heparin is prescribed in the first day. During recovery the patient is allowed to stand, if the temperature is normal during the week, the ESR is not higher than 30 mm / h, there is no sensation of crawling in the extremities.