Thromboembolic complications in the postpartum period

Objective. Analysis of the features of patient management tactics depending on the location and embolism of the thrombus and assessment of the role of screening duplex scanning of veins in patients in the postpartum period for the prevention of pulmonary embolism. Materials and methods. In the Mother and Child group of companies, from 2015 to 2023, all maternity hospitals underwent screening examinations of the deep and superficial veins of the lower extremities and small pelvis. 417 (1%) cases of venous thromboembolic complications were detected among 42.431 births in hospitals of the Mother and Child Group. The article considers 4 clinical observations: in two postpartum women, acute thrombosis with a floating part of a vena cava thrombus emanating from the right gonadal vein was detected, one had thrombosis of the large subcutaneous vein of the femur, and one had ileofemoral thrombosis. Results. Mandatory ultrasound screening of the superficial and deep veins of the lower extremities and small pelvis revealed a high incidence of venous thromboembolic complications, which exceeded the published data by more than 10 times. The study showed that asymptomatic postpartum gonadal vein thrombosis prevails (49.4%). In 48 (11.5%) cases, surgical treatment was required. Due to the risk of embolization of venous thrombosis of both the lower extremities and the small pelvis, it is necessary to include ultrasound screening of these veins in the clinical recommendations as a mandatory method for carrying out in the postpartum period. Conclusion. For effective prevention of venous thromboembolic complications, it is necessary to conduct a thorough medical history collection in pregnant women and a point assessment of the risk of developing such complications. In addition, one of the main risk factors for developing thrombosis after childbirth is surgical delivery, especially emergent, as evidenced by all the clinical observations given in this article.