Clot review PPH

Pregnancy clotting state

Prothrombotic state (↑ clotting factors, ↓ fibrinolysis)

Hemostatic system

Clot formation via coagulation factors, platelets, endothelium

Fibrinolytic system

Breaks down clots (prevents excessive coagulation)

Postpartum CV changes

↓ blood volume, ↓ BP, ↑ WBC, ↑ clotting factors

Postpartum clot risk

Increased fibrinogen → ↑ thromboembolism risk

DVT definition

Blood clot in deep vein (usually legs)

VTE definition

Clot(s) in veins (includes DVT + PE)

PE definition

Clot travels to pulmonary artery (medical emergency)

DVT cause in pregnancy

Hypercoagulability + venous stasis

Postpartum DVT risk

Higher after cesarean birth

DVT risk factors (pregnancy)

Obesity, diabetes, multiple gestation, age

DVT risk factors (postpartum)

C-section, hemorrhage, smoking, BMI ≥35

High-risk history

Prior VTE, thrombophilia

Virchow's triad

Stasis, endothelial injury, hypercoagulability

Stasis example

Slow blood flow in dilated veins

Endothelial injury example

Surgery, placental detachment

Hypercoagulability cause

Pregnancy, estrogen, postpartum state

DVT S/S

Unilateral leg pain, swelling, redness, warmth

Classic DVT finding

Calf tenderness, swelling >2 cm difference

Severe DVT signs

Pale, cool leg, ↓ pulses

Superficial thrombosis

Pain, redness, cord-like vein

Superficial vs DVT

SVT = self-limiting, DVT = risk for PE

DVT diagnosis

Ultrasound (compression)

D-dimer test

Elevated if clot breakdown present (>0.50)

PT test

Extrinsic pathway (11-13 sec)

PTT test

Intrinsic pathway (25-30 sec)

aPTT

Purpose Monitor heparin therapy

INR normal therapeutic range

2-3

Low INR

Clots too fast (↑ clot risk)

High INR

Bleeding risk (↑ hemorrhage)

DVT treatment

Heparin IV → warfarin postpartum

Preferred anticoagulant in pregnancy

Heparin (does NOT cross placenta)

Warfarin in pregnancy

Contraindicated (teratogenic)

Anticoagulants in postpartum

Heparin + warfarin safe in breastfeeding

DVT nursing care

Elevate leg, warm compress, compression stockings

Important precaution

NO pneumatic compression on active DVT (can dislodge clot)

DVT prevention

Early ambulation, leg exercises, compression devices

High-risk prevention

LMWH prophylaxis

PE symptoms

Dyspnea, chest pain, cough, sweating

PE diagnosis

V/Q scan or CT pulmonary angiography

PE priority

Start anticoagulation immediately

PE mortality

Accounts for ~9.2% maternal deaths

Patho of thrombus

Clot forms → breaks → embolus travels

Long-term complication

Post-thrombotic syndrome (valve damage)

Key pregnancy clot risk reason

↑ estrogen → ↑ clotting factors