Maternity leg. A postpartum leg is a blockage of a deep vein (thrombosis) in the leg during the first six weeks after delivery.
It occurs in two in a thousand women during the postpartum period, usually at the end of the first or the beginning of the second week after delivery.
How do you recognize a maternal leg?
- the leg is swollen and has a reddish-purple color
- the leg is often painful too
- the leg may feel a little warmer than the other leg
- sometimes the skin looks shiny
If the clot does not dissolve on its own, the leg will get thicker. At some point it can discolor again and then become whiter than the other leg. The leg is often extremely painful.
You do not have to constantly pay attention to the legs; if you develop a maternal leg, this is clearly noticeable. The maternity nurse and the midwife also pay attention to it.
How does a maternal leg develop?
A postpartum leg is a blockage of a deep vein (thrombosis) in the leg during the first six weeks after delivery.
The vein normally carries the blood from the legs back to the heart. This is no longer possible due to a clot in this vein. This causes the symptoms of the maternal leg.
Thrombosis in the leg is caused by a combination of major hormonal changes after delivery and reduced muscle activity in the legs. In some women predisposition also plays a role.
Hormonal changes The blood vessels are widened and weaker due to hormonal changes and more clotting factors are produced during pregnancy. This makes the blood clot more easily.
Reduced muscle activity Because a maternity woman spends a lot of time in bed, the flow of blood in the legs decreases. Normally the calf muscle (especially when walking) ensures that the blood is pumped up. Of course, this happens much less with bedridden. The blood flow is therefore slower, which makes it easier to deposit in the vessels. Compare it with running water. Fast flowing water produces much less siltation than slow-flowing water. This also applies to blood flow. Slower flow further promotes the clotting of the blood.
Tendency In some women, the blood has always had an increased tendency to clot; it, therefore, runs in their family. These women have a higher risk of thrombosis. Often they have previously had thrombosis outside of pregnancy. They run an extra risk of having a childbirth leg. Women who have had a cesarean section also have an increased risk of having a childbirth leg.
Is it serious and what can you expect?
A maternity leg should always be taken seriously. An incipient childbirth leg can pass spontaneously. When the leg becomes thicker and more painful, it will not go away on its own.
Examination The doctor will examine your leg. Sometimes he chooses to look at the leg again a day later. If the doctor also thinks of a thrombotic leg, he will refer you to the hospital. There an ultrasound of the blood vessels of the leg is made. This makes it possible to quickly assess whether there is a thrombosis. Sometimes blood is also taken to see if there are indications of thrombosis in the blood.
Treatment with heparin If there is indeed a thrombosis in your leg, you will be given an anti-clotting medication. This medicine is called heparin. Sometimes you will receive this in the hospital via an IV, but it can also increasingly happen at home. You will then be injected with the anticoagulant medication under the skin. You can give these injections yourself. You can also have them done by your partner or the home care provider. Heparin works within hours.
Treatment with acenocoumarol In addition to heparin, you will also receive other anti-coagulant medicines in tablet form. Usually acenocoumarol is given for this. It takes several days for the resources to work properly. Only when it does will the heparin be stopped.
It is determined individually for each person how many tablets are needed to keep the blood properly coagulated. This requires blood samples to be taken regularly, once a week or two weeks. This is done by the Thrombosis Service.
The doctor of the thrombosis service will put on a card how many tablets you should use per day. You must swallow the tablets for at least three months to prevent another thrombosis.
You can breastfeed normally while taking these medicines. Your child must then be given extra vitamin K.
Possible sequelae The thrombotic bone usually heals on its own with this treatment. However, the leg can continue to look a bit different. In one in four women, the leg always remains thicker and wounds are easily formed that are difficult to heal. Varicose veins also often develop and the woman is more likely to suffer from a tired feeling in that leg. Such a leg with residual complaints is called a post-thrombotic leg. In the next pregnancy, you will receive heparin again from delivery to prevent a new birth bone. In any case, you will receive anticoagulants for up to three weeks after delivery, again in combination with tablets (see above under ‘treatment with acenocoumarol’).
When to go to the doctor?
If you think you have a maternal leg, you can contact the general practice. The general practitioner can assess whether there is indeed a maternal leg. If necessary, he will refer you to the hospital.
What can you do about it yourself?
Once you have a maternal leg, you cannot do much about it yourself. Treatment with drugs is necessary.
General advice and precautions
If you have to stay in bed If you have to stay in bed during the maternity period, it is important to move the legs regularly to improve blood flow.
You can do this by doing the following exercises a few times a day. Do the exercises with both the left and the right leg.
- Exercise 1 Make circles with your ankle ten times to the right and ten times to the left.
- Exercise 2 While lying on the bed, pull your foot over the bed towards the buttocks and then slide it back again. Ten times with each leg.
- Exercise 3 Lift the leg slightly off the bed and make a kicking movement with the lower leg.
If you don’t have to stay in bed When there is no reason to stay in bed, it makes sense to walk small pieces regularly.
Women who have had a caesarean section or pre-eclampsia will be treated in hospital with anticoagulants as a precaution because they have a higher risk of a childbirth leg.
Women who have previously had thrombosis are also eligible. It is therefore important to report this to your midwife or gynecologist. You will then be treated with anticoagulants as a precaution, often during pregnancy and certainly during childbirth.
Women with complaints as a result of a post-thrombotic leg often benefit greatly from wearing an elastic stocking. This counteracts the annoying swelling of the leg during the day and provides extra support for the pumping function of the calf muscle. This promotes better blood flow back to the heart.
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