The postpartum period, a stage of increased risk of venous thrombosis that requires early diagnosis

Venous thrombosis in the postpartum period is one of the main causes of non-obstetric maternal morbidity. Although it is rare, it represents a medical emergency that requires rapid diagnosis and appropriate treatment. This is explained by Dr Pablo Gallo González, head of the Angiology and Vascular Surgery Unit at Ruber Internacional Hospital, and Dr Santiago Zubicoa Ezpeleta, head of the Vascular Radiology Unit at the same centre, who emphasise that information and early detection are essential to protect maternal health.

‘The postpartum period is a time when the body is physiologically predisposed to forming clots, so clinical monitoring must be particularly rigorous,’ says Dr Pablo Gallo. This natural prothrombotic state is a defence mechanism against haemorrhage, but it can promote the development of venous thromboembolic disease (VTE), which includes deep vein thrombosis (DVT), pulmonary thromboembolism (PTE) and thrombophlebitis.

A high-risk period

During the first 40 days after delivery, a combination of factors increases the likelihood of thrombosis. Dr Gallo explains that these factors correspond to Virchow's well-known triad:

Venous stasis, due to compression of the pelvic veins by the uterus.
Endothelial injury, secondary to delivery or procedures such as caesarean section.
Hypercoagulability, due to the physiological increase in coagulation factors such as fibrinogen.
Added to this are other risk factors such as hereditary or acquired thrombophilias, personal or family history of thrombosis, pelvic varicose veins, obesity, immobilisation, smoking, maternal age over 35, or complications such as postpartum sepsis.

Key symptoms that should not be overlooked

‘The problem with thrombosis in the postpartum period is that its symptoms can be confused with common postpartum discomforts, so it is essential to recognise the warning signs,’ says Dr Zubicoa. These include:

Pain in one leg, pelvis or abdomen.
Swelling of a limb, especially the left leg.
Persistent fever with no apparent cause.
Dyspnoea or chest pain, suggestive of a possible PTE.
Presence of an inflamed and painful venous cord.
Diagnosis and treatment: speed makes the difference

Diagnosis begins with a clinical assessment and additional tests. ‘Venous Doppler ultrasound is the initial tool due to its speed and reliability,’ explains Dr Zubicoa. If pulmonary embolism is suspected, pulmonary CT angiography is used, and in complex pelvic thrombosis, MR angiography.

Treatment depends on the severity of the condition. As Dr Pablo Gallo points out, ‘anticoagulation is the basis of management, accompanied by relative rest and compression stockings’. In severe cases or those with poor response to treatment, more advanced interventions may be necessary, such as thrombectomy, pharmacological/mechanical thrombolysis or, in exceptional situations, vena cava filters to prevent pulmonary embolism.

Both specialists agree that prevention is crucial in women with risk factors. Measures such as prophylactic low molecular weight heparin (LMWH) for 4–6 weeks, early mobilisation, use of compression stockings and avoiding a sedentary lifestyle significantly reduce the risk.

‘Venous thrombosis in the postpartum period can be serious, but identifying it early and acting quickly saves lives,’ concludes Dr Gallo. Knowledge, vigilance and early care remain the most effective allies in protecting maternal health during this crucial period.