A woman scheduled for a C-section has enough on her mind already, doesn’t she? A new baby, a new life, a new list of things to do. Does she also have to worry about an increased risk of blood clot development following a C-section?
In some scenarios, a woman doesn’t even know she’ll need a C-section until the birth is imminent. In such cases, the flurry of activity doesn’t allow for too many questions. For those whose births are scheduled, preparation is the key to understanding the process and its associated risks.
C-section and blood clot risk
C-sections are often recommended when a baby is in distress, in an abnormal position, or the labor isn’t progressing as needed. Even though a C-section may be recommended and often vital for the optimal wellness of mother and baby, there are risks to the procedure.
One of those risks is heavy bleeding during or following delivery, known as postpartum hemorrhage. For some women, C-sections increase the risk of blood clot development inside deep veins, especially those found in the pelvic organs or the legs, otherwise known as a deep vein thrombosis or DVT.
A DVT poses a risk of breaking off and traveling to the lungs, blocking flow of oxygenated blood back to the heart. At that point, the blood clot is known as a pulmonary embolism. The damage it causes can be severe and potentially life-threatening.
What’s the risk of developing a blood clot following a C-section?
Blood clotting factors in the body are a natural process to stop bleeding from blood vessels and initiate healing processes. Among the most common causes of postpartum hemorrhage is an inability of the uterus to contract. These contractions naturally aid in stopping bleeding following the birth process. Retention of placental tissue and/or infection can also contribute to the potential for blood clots.
While it’s not always possible to circumvent all risks involved in any surgical procedure, C-sections are relatively safe. Even so, if your physician determines that a scheduled C-section is the safest delivery method for you or your baby, be willing to ask questions, discuss risks, and what you can do to prevent blood clots prior to the procedure.
Blood clotting is also a normal process following any type of invasive surgery where blood vessels may have been severed or otherwise injured or interfered with. Postsurgical or post C-section clotting is typically at its highest risk within six weeks postpartum, although clots can also occur during the following six weeks. In most cases, risks for developing a blood clot postpartum typically decreases following 12 weeks post-delivery.
It should be noted that it is relatively normal for women to experience bleeding as well as to pass some blood clots post-partum as the uterus contracts and returns to its normal size. However, watch for signs of potential blood clotting dangers that include:
- Rapid heart rate
- Pain, warmth, or swelling and redness in one leg (potential signs of DVT)
- Chest pain
- Shortness of breath
- Clammy or chilled skin
If you’re pregnant and your doctor has recommended a C-section delivery, discuss concerns prior to the procedure and follow instructions for decreasing your risk of potential dangerous blood clots post-procedure.
A definitive diagnosis of the presence of a blood clot can be performed at your doctor’s office or hospital setting. Depending on the suspected location of the blood clot and the type, a physician has a number of options at his or her disposal. Among them include:
- Blood tests
- CT scans
How do blood clot diagnostic tests work?
In the case of a suspected pulmonary embolism (PE), your doctor or a physician will start with the physical exam, looking for signs of swelling, tenderness, discoloration or warmth in the legs. Why the legs when the pulmonary embolism is a blood clot found in the lung? Because pulmonary embolisms are commonly caused by a blood clot that has formed in the lower extremities or the thighs, known as a deep vein thrombosis or DVT.
In some cases, the blood clot breaks off from the wall of the blood vessel of the leg and travels upward through the circulatory system. It may ends up lodged in one of the pulmonary or lung blood vessels.
In such cases, a doctor will order numerous tests including chest x-rays or ultrasound. Blood tests may also be recommended in order to determine levels of oxygen and carbon dioxide in the blood. Blood tests also enable the physician to detect presence of D dimer, which is a protein fragment typically found in blood after a blood clot has been dissolved or broken down by the body.
Computed tomography or CT scans may go a step further. In some cases a physician may recommend a computer tomographic angiography (CTPA) - a type of x-ray test that most physicians utilize to diagnose a pulmonary embolism.
One of the most definitive test to determine presence of a pulmonary embolism is a test called a ventilation/perfusion scan, otherwise known as V/Q. This test involves insertion of a catheter into one of the large veins in the groin, and one into an artery that services the lung. A dye is injected into the catheter and will show up on an x-ray. In this way, the doctor can locate the blockage.
Some blood clots that end up in the lungs can damage the heart due to lack of oxygen. In such cases, an echocardiogram may be recommended, otherwise known as a heart ultrasound. The echocardiogram or ECG is not used as a diagnostic test for PE, but it does show if the heart is being affected by the pulmonary embolism.
In order to detect a deep vein thrombosis or DVT, a physician will also begin the diagnostic process through visual examination. One of the most common diagnosis tests for DVT diagnosis is the ultrasound, a technique that utilizes sound waves to create an image of arterial and venous flow in the affected leg.
As with the PE, a D dimer test may also be recommended, as well as venography, which, like the V/Q test, utilizes a dye injected into a vein, enabling an image of the vein to be displayed on an x-ray to show if blood flow has slowed or stopped in the vein.
Treatment options will depend on the testing results.
Pulmonary embolism defines the sudden blockage of a pulmonary artery inside the lung by an embolus, typically from a blood clot that has an origin somewhere else in the body such as a deep vein thrombosis of the leg. When it comes to defining signs and symptoms of a pulmonary embolism, the distinction in terminology is important. Signs are visible, while symptoms are expressed by what a patient feels.
The most common type of embolus traveling to the lungs is caused by a DVT that has become dislodged and travels upward until it reaches the lungs.
A number of causes for blood clots forming in the lower extremities include prolonged bed rest, immobility from long journeys, or an injury, typically caused by fractures damages surrounding vessels and tissues.
Signs of pulmonary embolism
Awareness of potential signs and symptoms of pulmonary embolism enables (and encourages) individuals to seek medical attention. It should be noted that pulmonary embolisms are extremely serious situations and have the potential to cause death.
Among the most common signs – something that someone can observe, when it comes to a pulmonary embolism include:
- Shortness of breath – this shortness of breath or difficulty breathing typically comes on suddenly. Breathing may be rapid.
- Response to anxiety (a symptom) that is viewed by pacing or verbal expressions of worry.
- Responses to sudden, sharp pains in the chest, especially during inhalation. This pain is called pleuritic chest pain.
- Blue-tinged skin is an indication that oxygen deprivation is occurring. Bluish-tinged lips and fingertips are the first indication that the lungs are not oxygenating blood adequately.
- Individuals who experience recurring (small) pulmonary emboli may also display swollen ankles or legs, and experience generalized weakness.
Other indications of possible pulmonary embolism are expressed in symptoms such as complaints of lightheadedness. An individual may also complain about an erratic heart rate.
A pulmonary embolism can also cause a pulmonary infarction, or lung tissue death. In such cases, seek emergency help immediately. Pulmonary infarction can trigger bouts of coughing that bring up bloody sputum. This emergency also causes severe and sharp chest pain.
Prevention of pulmonary embolism
Surgical procedures, blunt force injury and trauma, obesity, and inactivity all increase the risk of blood clots. A pulmonary embolism occurs when such clots break off and travel to the blood vessels serving the lungs, the heart, or the brain. Each may cause severe damage and even death.
Prevention methodologies include adequate hydration, weight loss if needed, increased mobility (under physician supervision), and careful observance following any surgical procedure, long-term bed rest, or chronic illness. If you feel you are at risk for a pulmonary embolism, discuss signs, symptoms, diagnostics, and potential treatments with your physician.
Foods that Help Prevent Blood Clots
Blood clots form for a number of reasons: a surgical procedure, obesity, a medical condition, or an injury. Blood thinning and anticoagulation medications are commonly prescribed to prevent blood clots for individuals at risk. In addition to medication, a number of foods prove beneficial in preventing the development of blood clots.
Blood clots are commonly formed as a normal process in the body known as coagulation. In some cases, blood clotting is essential to prevent excessive bleeding, to promote healing, and reduce the risk of infection. In other cases, a blood clot can be deadly.
A number of conditions increase the risk of developing a life-threatening blood clot, such as higher ratios of "bad" cholesterol than "good" cholesterol. High levels of triglycerides (a type of fat found in the blood) also increase risk of blood clot formation.
Higher than normal levels of bad cholesterol causes atherosclerosis or buildup of plaque inside artery walls. Plaque buildup narrows blood vessels, causing blood flow to slow down (much as a closed lane on a freeway), increasing the risk of developing a blood clot. A blood clot that breaks off and floats through the bloodstream can easily block an artery or cause a stroke, heart attack, or a pulmonary embolism (PE).
How can food prevent a blood clot?
A nutritious and well-balanced diet containing a variety of phytochemicals is the first step toward promoting circulation and arterial and venous blood flow. Phytochemicals are physiologically active compounds found in many plants. While not generally considered essential nutrients, they have shown benefits in reducing potential for heart disease and cancer.
Foods containing flavonoids and phenols may prove beneficial in clot prevention. Flavonoids reduce plaque buildup in arteries, improve cholesterol levels, act as antioxidants, and decrease inflammation. Foods and beverages containing flavonoids and phenols include:
- fruits (grapes, cherries, apples, prunes, pears, citrus)
- whole grains
- black or green tea
- red wine
Phytoestrogens such as legumes and soy products protect against heart disease by decreasing levels of bad cholesterol and increasing levels of good cholesterol.
Organosulfur compounds such as leeks, onions, and garlic protect the heart because they reduce production of cholesterol in the liver.
Hydration is also an essential component of adequate circulation. Dehydration causes the blood to thicken, increasing risk of poor circulation and development of a blood clot.
Talk to your doctor or a nutritionist to ensure that your diet is protecting rather than harming you.
Does Aspirin Cause Blood Clots?
Aspirin is an over-the-counter product that’s been used for generations, not only to reduce pain and fever, but for other benefits as well. Does aspirin cause blood clots? No. That doesn’t mean that using it is without risks for some.
One of the benefits of low-dose aspirin (around 75 mg to 80 mg) daily has the potential to reduce risk of heart attack in those diagnosed with certain heart conditions. Daily aspirin therapy is nothing new but should always be recommended and monitored by a physician, as not all cardiac care cases are the same.
The components in aspirin interfere with the body’s automatic blood-clotting mechanisms. This can be beneficial to some, detrimental to others. The concept with cardiac care patients is that aspirin restricts the body’s ability to clot blood, thereby acting much like a blood thinner and reducing risk of a clot that reaches the heart.
Aspirin acts as a blood thinner by reducing the ability of blood platelets – a component of blood that contain anti-clotting factors – to clump together. This clumping mechanism is the early process of forming a blood clot.
Aspirin therapy risks need to be considered
Not everyone should take an aspirin a day (even if it’s low-dose) to prevent possible blood clots from forming. The body is supposed to trigger blood clotting factors to stop bleeding from an injured blood vessel. Only those who have had a heart attack, stroke, a stent placed, or someone at high risk for heart attack or stroke should consider it and then only when it’s recommended by your physician. The same goes for people diagnosed with additional co-morbidities such as diabetes or high blood pressure.
Those considering daily aspirin therapy should know that risks of bleeding increases with aspirin use, especially among those taking the daily aspirin who don’t have cardiovascular issues.
Aspirin therapy does not guarantee that blood clots won’t form in the body or prevent a deep vein thrombosis (DVT) from forming in the leg. According to the American Heart Association, potential users are cautioned that taking aspirin daily as a blood thinner can contribute to other risks for some users, such as:
- Those who have developed an allergy or intolerance to it
- Those who are habitual alcohol drinkers
- Those who are at risk of a hemorrhagic stroke
- Those who are at a risk for gastrointestinal bleeding
While aspirin doesn’t cause blood clots, it’s always best to consult with your doctor before starting on any aspirin therapy as a preventative for blood clot development.
We’ve all felt it – that teeth-grinding muscle spasm in the arch of the foot, the back of the calf, or the back of the thigh (hamstrings). When do you know if that Charlie Horse is more than a muscle cramp? What if you get them often? How can you tell the difference between a Charlie Horse and a possible blot clot?
Charlie Horse vs. Blood Clot
A Charlie Horse is a nickname for a muscle spasm or cramp. This cramping or contraction of a muscle or group of muscles can be incredibly painful. Depending on the duration of a Charlie Horse, pain can be quite severe and soreness may exists for hours or even up to a day afterward.
A blood clot is known as a thrombus. Blood clots usually form over an injury to a blood vessel. Any time a blood vessel is injured, the body sends a signal to the brain. The brain then signals a rush of blood platelets and clotting factors to the area. Platelets are sticky blood cells that clump together to bind to the wall of the vessel to stop bleeding or leaking from a tear or injury to the wall of a blood vessel.
So which is it? A blood clot or a Charlie Horse?
Charlie Horses are caused by a number of situations, such as:
- A muscle injury
- Inadequate blood flow (blood transports oxygen – lack of blood flow decreases oxygen to the body’s cells in the affected area)
- Exercising in very hot or very cold weather
- Muscle strain or overuse
Several of the above situations that trigger a Charlie Horse may also increase risk of blood clot development, especially dehydration and inadequate blood flow, such as remaining sedentary for long periods of time. Dehydration causes blood to thicken and blood flow to decrease, causing it to grow sluggish as it moves through the blood vessels. When blood flow slows down, an increased risk of blood particles sticking together to form clots occurs.
Experiencing a Charlie Horse once in a while is not usually a cause for concern. In many cases, they respond almost immediately to massage, stretching, or ‘walking it off’. However, if you experience a Charlie Horse more than once a week, it’s recommended to schedule a visit with your physician to determine the underlying cause.
A special thank you to Richard M. Cohen for helping the American Blood Clot Association to educate the public about the danger of blood clots. Mr. Cohen has been the recipient of numerous awards in journalism, including three Emmys, a George Foster Peabody and a Cable Ace Award. He is married to journalist, Meredith Vieira of the Meredith Vieira Show, with whom he has three grown children. Here is his story, it is a great video:
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