Maternity
You have been asked to attend a clinic to review your risk of developing blood clots in pregnancy.
Introduction
This leaflet is for pregnant women. It gives information about blood clots in pregnancy, what causes them and what you can do to help prevent them.
What are blood clots?
Venous thromboembolism (VTE) is a term for both deep vein thrombosis (DVT) and pulmonary embolism (PE).
Deep vein thrombosis (DVT)
A DVT is a blood clot in the deep veins most commonly occurring in the leg or pelvis. It can partially block or reduce the flow of blood in a vein. The most serious complication of DVT is PE.
Pulmonary embolism (PE)
A PE is when all or part of the DVT breaks off, travels through the body and partially blocks the blood vessels to the lungs. This can be potentially life threatening.
What are the signs and symptoms of DVT
What are the signs and symptoms of a PE
Why could I be at increased risk of blood clots during pregnancy?
During pregnancy, the blood clots more easily to reduce the risk of excessive blood loss during labour and delivery. Pregnant women may also experience less blood flow to the legs later in pregnancy because the blood vessels around the pelvis are compressed by the growing baby.
Although there is a risk of VTE in all pregnancies we do not offer preventative treatment to everyone. You are assessed as an individual to identify whether you have any additional risk factors which will further increase your risk of developing blood clots.
These include:
Why have I been referred
Dependent on the amount of additional risk factors you may have, you will be referred to either the Midwife led VTE clinic or the Anti coagulation Nurse clinic to discuss the risks and benefits of having preventive treatment for VTE.
The timing of this appointment will be dependant on the outcome of your risk assessment.
For some pregnant people preventative treatment is recommended from confirmation of the pregnancy, for other pregnant people it is recommended from 28 weeks gestation or whenever a new risk factor is identified. If a referal is recommended by your Doctor or Midwife they will let you know when you would need to start the medication.
It is essential that you have a blood test prior to starting your treatment. This is to ensure that there are no concerns with the clotting of your blood, kidney or liver functions. A blood test request will have been completed for you prior to your appointment. Instructions will be on your appointment letter/text.
What treatment is there to help prevent blood clots?
In pregnancy we cannot offer oral medication to reduce the risk of VTE. Oral medication is not licensed for pregnancy as medication such as Warfarin can lead to an increased risk of miscarriage and fetal abnormalities. The treatment that is recommended is called Heparin and is given by a small injection; this is given every day. These injections will continue throughout pregnancy and for 40 days after delivery. You will be taught to self-inject, this can sound daunting but is quite simple and soon becomes part of your day-to-day routine.
Will the treatment affect my baby?
Heparin does not cross the placenta so it is safe for your developing baby and it is safe if you are breastfeeding.
How do I give these injections?
Heparin injections are supplied in prefilled syringes which require no measuring.
The nurse or midwife will teach you how to self inject when you attend your VTE clinic appointment.
We advise that these injections are administered at a 90 degree angle into the the abdomen, alternating sites everyday avoiding the area immediately around the belly button.
There is no risk to the baby from administering in the abdomen.
These injections can also be administered into the tops of your legs avoiding the inside of your legs where deep veins are located.
You will be supplied with a sharps bin for your used syringes. When this is full please return the bin to the hospital and we can exchange it for you. All other packaging can be disposed of in your household waste.
We will supply all of your injections for you.
DO NOT allow your supply of injections to run out. Please contact the department where your treatment was initiated for further supplies.
Please bring your injections with you when you are admitted to hospital for the birth of your baby.
Staff on the maternity ward will ensure you have enough injections for 40 days after delivery of your baby prior to discharge home.
Do these treatments have side effects?
There are minor side effects from heparin. You may find you have bruising/ small bumps around the injection site and stinging on administering the injections.
Occasionally allergic reactions such as rash and itching at injection sites may develop. If this happens please contact the department that initiated your treatment and an alternative brand can be prescribed.
What happens if I have bleeding or a miscarriage?
If you experience bleeding in early pregnancy please attend A&E.
Heparin injections will not cause you to bleed/miscarry.
If you experience any vaginal bleeding seek medical advice prior to taking further injections.
If your pregnancy sadly ends you will need to continue your injections for 40 days post miscarriage until your body returns to a pre-pregnant state.
Will the treatment affect labour and delivery?
What follow up will I receive
You will receive a letter around 34-36 weeks of pregnancy to remind you how to manage your injections around labour and delivery.
Although we do not normally see you again in clinic we are available if you have any concerns call 01384 456111 extension: As below
Midwife led VTE clinic (Friday only) -1369
Midwifery triage – 3053
Anticoagulation Clinical Nurse specialist -2890
VTE prevention Nurse -1805
What else can I do to help prevent blood clots?
Can I find out more?
You can find out more from the following web link:–
https://www.nhs.uk/pregnancy/related-conditions/complications/deep-vein-thrombosis
If you have any questions, or if there is anything you do not understand, please contact the Russells Hall Hospital switchboard number on (01384) 456111 and ask for the relevant department who issued this leaflet.
This leaflet can be made available in large print, audio version and in other languages, please call 0800 073 0510.