3.4  Deep vein thrombosis (DVT)

Deep vein thrombosis (DVT) — a blood clot, almost always in one of the deep veins in the legs — is a rare complication during the puerperium. However, when it occurs it can be rapidly fatal if the clot breaks away from the vein in the leg and travels to the heart, lungs or brain, blocking vital blood vessels.

The chance of developing a DVT is more common during pregnancy than in the non-pregnant state, and the risk increases during the puerperium. Why deep veins in the legs develop clots (thrombosis) is not exactly known. However, the risk is much higher when the postnatal woman spends most of the time in bed and doesn’t walk about much for several days after the birth. In most parts of Ethiopia, the local custom is for postnatal women to remain in bed, with no activity except a short walk to use the latrine. So it is important for you to identify the clinical features of DVT, make a diagnosis and refer her to a hospital as early as possible. Box 3.2 shows the common clinical features of DVT.

Box 3.2  Clinical features of deep vein thrombosis (DVT)

  • Pain in one leg only: usually sudden onset, persistent and aching type of pain.
  • Tenderness: the area is painful when you touch it.
  • Swelling: the affected leg is swollen with greater than 2 cm difference in circumference compared to the other (healthy) leg. The swelling may be in the calf or the thigh.
  • Palpable cord: you may feel a cord-like structure deep in the swollen leg.
  • Change in limb colour: the affected leg appears a little bit red.
  • Calf pain: she will feel pain when you try to do extreme extension at the ankle joint.

3.3  Screening for postpartum hypertension

3.5  Psychiatric disorders in the postnatal period