Pregnancy Week by Week : Week 21 (part 2)

Blood Clots in the Legs

A serious complication of pregnancy is a blood clot in the legs or groin. Symptoms include swelling of the legs accompanied by leg pain and redness or warmth over the affected area in the legs.

This problem has many names, including venous thrombosis, thromboembolic disease, thrombophlebitis and deep-vein thrombosis. The problem is not limited to pregnancy, but pregnancy is a time when it may be more likely to occur due to blood flow slowing in the legs and changes in blood-clotting mechanisms.

The most probable cause during pregnancy is decreased blood flow, also called stasis. If you have had a previous blood clot—in your legs or any other part of your body—tell your healthcare provider at the beginning of your pregnancy. It’s important information.

Help protect yourself from developing the problem by exercising, not sitting for longer than 2 hours, not smoking and not wearing tight clothing at or below your waist. Surgical stockings may help prevent the problem; heparin may be recommended in severe cases.

Superficial and Deep-Vein Thrombosis (DVT). Superficial thrombosis and deep-vein thrombosis are different conditions. Superficial thrombosis is a blood clot in veins close to the surface of the skin. You can see and feel these veins. This situation is not as serious and is treated with a mild pain reliever, elevation of the leg, support of the leg with an Ace bandage or support stockings, and occasionally heat.

Superficial thrombosis does not result in pulmonary embolism (PE). Pulmonary embolism is blockage of blood flow in the lungs; it results in failure of the lungs to work. If the condition doesn’t improve rapidly, deep-vein thrombosis must be considered. DVT is more serious because a clot can travel from the legs to the lungs and cause PE.

Deep-vein thrombosis (DVT) affects nearly 2 million Americans every year; a very small percentage of them are pregnant women. Although it’s a serious complication, it can often be avoided with early treatment. If you’ve had any blood clot in the past, see your healthcare provider early in pregnancy. Tell him or her at your first prenatal visit about any previous blood clots.

DVT is a blood clot that forms in the large veins in your legs. It’s caused by blocked blood flow and changes in blood clotting during pregnancy. Onset can be rapid, with severe pain and swelling of the leg and thigh.

Symptoms of deep-vein thrombosis in the lower leg can differ, depending on the location of the clot and how bad it is. Symptoms include swelling in the leg, worsening cramp or pain in one leg, discoloration of the leg, including turning red, blue or purple, and/or a feeling of warmth in the affected leg. Often skin over the affected veins is red. There may even be streaks of red on the skin over veins where blood clots have occurred. If you have any of these symptoms, call your healthcare provider immediately.

Squeezing the calf or leg may be extremely painful, and it may be equally painful to walk. One way to tell if you have deep-vein thrombosis is to lie down and flex your toes toward your knee. If the back of the leg is tender, it can be a sign of the problem; this is called Homan’s sign. (This type of pain may also occur with a strained muscle or a bruise.) Check with your healthcare provider if this occurs.

Ultrasound is usually used to diagnose the problem. Most major medical centers offer it, but the test is not available everywhere.

Treating DVT. Treatment usually consists of hospitalization and heparin therapy. Heparin and Lovenox (enoxaparin) are both anticoagulants. They are given intravenously and are safe to use during pregnancy.

While heparin is being administered, the woman is required to stay in bed. The leg may be elevated and heat applied. Mild pain medicine is often prescribed.

Recovery time, including hospitalization, may be 7 to 10 days. The woman will need to take heparin until delivery. Following pregnancy, she will need to continue taking an anticoagulant for up to several weeks, depending on the severity of the clot.

If a woman has a blood clot during one pregnancy, she will probably need heparin during her next pregnancies. If so, heparin can be given by an in-dwelling I.V. catheter or by daily injections the woman gives herself under her healthcare provider’s supervision.

An oral medication used to prevent or to treat deep-vein thrombosis is warfarin (Coumadin). It is not given during pregnancy because it can be harmful to the baby. Warfarin is usually given to a woman after pregnancy to prevent blood clots. It may be prescribed for a few weeks or a few months, depending on the severity of the clot.

5. How Your Actions Affect Your Baby’s Development

Safety of Ultrasound

Many women wonder about the safety of ultrasound exams. Medical researchers agree ultrasound exams don’t pose any risk to you or your baby. Researchers have looked for potential problems for many years without finding evidence of any.

Ultrasound is an extremely valuable tool in diagnosing problems and answering some questions during pregnancy. The information ultrasound testing provides can be reassuring to the healthcare provider and the pregnant woman.

If your healthcare provider has recommended ultrasound for you and you’re concerned about it, discuss it with him or her. He or she may have an important reason for doing an ultrasound exam. It could affect the well-being of your developing baby.

Eating Disorders—How Can They Affect Pregnancy?

About 7 million women in the United States have some type of eating disorder, and eating disorders are becoming more recognized in pregnant women. Experts believe as many as 1% of all pregnant women suffer from some degree of eating disorder. The two primary eating disorders are anorexia nervosa and bulimia nervosa. Other eating disorders include restricting calories or food, and weight obsession, but those afflicted with them don’t meet the anorexia or bulimia criteria.

Women with anorexia usually weigh less than 85% of what is normal for their age and height. They are often very fearful of becoming fat, have an unrealistic body image, purge with laxatives or by vomiting, and binge. Bulimia is characterized by repeated binging and purging; a woman may feel a lack of control over the situation. A bulimic binges and purges at least twice a week for a period of 3 months or more.

It’s often difficult for any woman to see her body gain the weight that is normal with a pregnancy. It may be even harder for a woman with an eating disorder to see the pounds add up. It may take a lot of hard work and effort to accept these extra pounds, but you must try to do it for your good health and the good health of your baby.

Eating disorders may worsen during pregnancy. However, some women find their eating disorder gets better during pregnancy. For some, pregnancy is the first time they can let go of their obsessions about their bodies.

If you believe you have an eating disorder, try to deal with it before you get pregnant. An eating disorder affects you and your baby! Problems associated with an eating disorder during pregnancy include:

• a weight gain that is too low

• a low-birthweight baby

• miscarriage and an increased chance of fetal death

• intrauterine-growth restriction (IUGR)

• baby in a breech presentation (because it may be born too early)

• high blood pressure in the mother-to-be

• depression during and after pregnancy

• birth defects

• electrolyte problems in the mother-to-be

• decreased blood volume

• low 5-minute Apgar scores, after baby’s birth

Your body is designed to provide your baby with the nutrition it needs, even if it has to take it from your body stores. For example, if your calcium intake is low, your baby will take the needed calcium from your bones. This could lead to osteoporosis for you later in life.

Sometimes visualizing what baby looks like at a particular time can help you. If it does, look at the illustrations of baby that accompany many of our weekly discussions. Each week read how baby is developing. Use this information to imagine how big your baby is and what it looks like at a certain time.

More frequent prenatal visits and monitoring during pregnancy are often recommended for a woman with an eating disorder. Researchers speculate eating disorders may disrupt the way nutrients are delivered to the baby, which could result in problems. Your healthcare provider will want to keep close tabs on how baby is growing. Antidepressants may also be used to help treat the problem. An eating disorder can also increase the risk of postpartum depression.

Talk to your healthcare provider about your problem as soon as possible. It’s serious and can be harmful to you and your baby.