Thrombophlebitis
- Inflammation of the blood vessel lining with the presence of clot formation. When these clots become dislodged in the systemic circulation, it is now termed as embolus.
- Postpartally, thrombophlebitis is an extension of an endometrial infection.
- Associated physiologic changes that occur postpartally, increases the risk of the woman to develop because blood clotting ability during puerperium is decreased.
- Risk factors include the following:
- presence of varicose veins
- obesity
- previous thrombophlebitis
- maternal age above 30
- multiparity
- genetics (thrombophlebitis in the family)
- Prevention comes simultaneously with prevention and management of endometritis.
Assessment:
- Positive pain and stiffness on affected part of leg.
- Positive Homan sign.
- Positive swelling as a result of impeded venous circulation.
Management:
- Prevent by encouraging early ambulation to enhance circulation to lower extremities preventing blood clot formation.
- Elevate affected leg and provide adequate bed rest.
- Administer anticoagulants as ordered such as heparin and Coumadin:
- side effects may include hematuria and increased lochia
- monitor blood coagulation studies especially prothrombin time
- have antidote for heparin and Coumadin toxicity readily available: protamine sulfate for heparin and vitamin K for Coumadin
- discontinue breastfeeding.
- Administer analgesics for pain. Acetylsalycilic acid (ASA or aspirin) are contraindicated because it inhibits prothrombin formation, which can result to bleeding.