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DVT and pregnancy

From: amanda hanson (amanda_hanson@und.nodak.edu)
Thu, 19 Sep 2002 13:48:54 -0500 (CDT)

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Hi, my name is Amanda Hanson and I am a Nursing Student at the University of North Dakota. During my OB clinical a patient had several risk factors for DVT. These factors included the hypercoagulability state of pregnancy, severe varicose veins, being of an age over 40, and having a parity of >3 (Aquila 2001). I did some research on this issue and would appreciate any knowledge, thoughts, or experiences related.

Quantrill (2001) states the incidence for venous thromboembolism is higher for pregnant women than for nonpregnant women. Nursing interventions that can be used (but are not regularly) include frequent repositioning, raising the legs above heart level, encouraging regular stretching of the legs and calf muscles and deep breathing exercises. Elastic stockings or intermittent pneumatic compression devices may also be helpful (Aquila 2001). Walling (2001) states the risk of venous thrombosis increases approximately fivefold during pregnancy. The risk is 0.5-3 per 1,000 pregnancies, yet pulmonary embolism is one of the leading causes of pregnancy-associated mortality and morbidity in the US. Nurses are taught to observe for DVT using the Homan's sign, but this sign is not a sensitive or specific test for DVT. The most common sign of DVT is asymmetry and slight unilateral edema in a lower extremity. A more accurate finding is pain that occurs when palpating the calf or along a vein (Aquila 2001).

What are the routine DVT prophylaxis measures offered in your hospital? In your estimation what percent of the time are the measures carried out? Pregnant women are at such high risk, that routine prophylaxis should be high priority. I would appreciate any response on DVT as to feelings, practices, and experiences on the issue. Thank you, Amanda Hanson, College of Nursing STudent, University of North Dakota.

References Aquila, A., (2001). Deep venous thrombosis. Journal of Cardiovascular Nursing, (15)4, p. 25-40. Walling, A., (2001). Thromboembolism in pregnancy: Clinical guidelines. American Family Physician, (63)3, p. 531-532. Quantrill, S., (2001). Deep vein thrombosis. British Journal of Periperative Nursing, (11)10, p. 442-448.

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