After delivery, your body discharges lochia, a menstrual period-like discharge consisting of blood, uterine tissues, and mucus, for four to six weeks. Lochia may also contain blood clots. Blood clots after birth usually form because the blood flow rate due to uterine wall shedding is higher than blood flow out of the body, causing the blood to collect in the uterus. Generally, the presence of a few plum-sized blood clots in postpartum discharge, especially in the first few days after delivery, is normal (1). However, if you notice too many clots or the clots are big, it may indicate an underlying problem. Continue reading as we tell you more about blood clots in the vaginal discharge, its risks, and tips on preventing blood clots after delivery.
Are Blood Clots Normal Post Delivery?
A blood clot is a mass of blood sticking together to form a jelly-like substance. Passing a few small blood clots is common after delivery. These clots reduce in size and frequency of appearance as the days pass(2). If you notice anything otherwise, seek prompt medical attention to avoid complications such as uterus atony, uterus rupture, tears in the vagina and cervix during delivery, preeclampsia, pieces of placenta which have remained inside the uterus after delivery, deep vein thrombosis or pulmonary embolism.
What Are The Symptoms Of Normal Blood Clotting After Childbirth?
Blood clots are common after childbirth and the amount discharged will reduce eventually. Here is a guide to help you understand the discharge of blood for up to six weeks post-delivery (3). The color and size of the clot and the amount of blood loss may get affected by the following factors:
Time of the day: The blood loss can be high in the mornings as the blood pools in the uterus when you lie down and flows down into the vagina when you stand up.
Breastfeeding: Release of the oxytocin hormone during breastfeeding also triggers the contraction of the uterus with or without pain. It is followed by a slight increase in the discharge of lochia.
Exercising: Gentle physical activities such as walking can also cause a heavy blood loss during the first two weeks post delivery.
If the blood clots are different than they usually are post-delivery, consult your doctor.
What Are The Symptoms Of An Abnormal Blood Clot?
Abnormal blood clotting could indicate deep vein thrombosis (DVT). If left untreated, it could lead to a life-threatening complication called pulmonary embolism (PE). DVT and PE are treatable and preventable, when discovered early (4). Therefore, look out for the symptoms of a dangerous blood clot (5): For deep vein thrombosis (DVT)
Swelling (in one leg or arm or pelvic area) Reddish or bluish skin discoloration Leg pain or tenderness often described as a cramp or Charley horse Leg or arm feels warmer on touch
If you notice any such symptoms, contact your doctor. However, you can have pulmonary embolism without any symptoms of deep vein thrombosis. Therefore, it is wise to check for the following symptoms as well: For pulmonary embolism
Shortness of breath Sharp or stabbing chest pain that may worsen when you take a deep breath Rapid heart rate An unexplained cough with or without bloody mucus
Apart from a recent delivery, there are some other factors that increase the risk of DVT and pulmonary embolism (6):
Previous blood clots A family history of blood clotting disorders Acquired thrombophilia Medical co-morbidities (sickle cell anemia, SLE, nephrotic syndrome, inflammatory conditions Maternal obesity Increased maternal age (over 35 years) Prolonged immobility (like bed rest or long distance travel) Multiple pregnancies Any medical condition like cancer or infections Dehydration Preeclampsia Prolonged labor Mid cavity rotational forceps delivery Postpartum hemorrhage
If pulmonary embolism is not treated, it could turn fatal. Timely diagnosis and treatment could avoid further complications.
How Are Blood Clots After Childbirth Diagnosed And Treated?
If DVT or pulmonary embolism is suspected postpartum, the doctor will suggest a few diagnostic tests before prescribing the ideal course of treatment (7) (8).
Diagnosis
D-dimer test: In the case of a suspected deep vein thrombosis, ultrasonography is done. Then, a blood test is carried out to detect the amount of D-dimer, which is a substance released from the blood clots. An abnormally high D-timer amount indicates that blood clots are circulating in the bloodstream.
CT scan: Computed tomography (CT) of the chest is carried out to detect pulmonary embolism. It is carried out after injecting a radiopaque contrast agent, which is a form of a dye, into the vein. The dye helps in clearing any blockage to give clear visibility inside the vein.
Apart from CT scan, a doctor might also prescribe for:
Ventilation-perfusion scan: Also known as V/Q scan or isotope lung scanning, it is prescribed to examine the flow of air and blood in the lungs. A part in the lungs with air in it but with no blood supply is indicative of pulmonary embolism (9).
Once the clot is diagnosed, prompt treatment is crucial. Depending on the severity of risk a clot could pose, the treatment plan is formed.
Treatment
The course of treatment would be suggested as per the severity of the condition (9): While you are undergoing treatment for blood clots, it is wise to consult your doctor about the safety of breastfeeding.
How To Prevent Blood Clots After Childbirth?
Here are some tips you can follow to prevent any blood clotting risks (11):
Be aware of the risk factors for blood clotting.
Stay active and keep moving regularly. Walking is the best activity postpartum.
Stay informed about the family history of this disorder.
Ensure that the doctor knows about your family history of blood clotting disorders.
Drink plenty of fluids to stay hydrated. Dehydration is one of the causes of DVT.
Always look out for any symptoms of a blood clot.
Do not use tampons for at least six weeks after delivery.
How To Care For Yourself?
Here are some tips you can follow in case of excessive blood flow:
Stock up sanitary pads for this period and avoid using tampons.
Keep your bladder empty as it helps in contracting the uterus and aids in reducing postpartum bleeding.
Wear compression stockings, if they are recommended to you.
Follow a healthy lifestyle. This includes eating healthy, exercising and quitting smoking (if you smoke).
If you are planning to travel after the treatment, check once with your doctor. Ideally, it is advised to avoid long journeys until at least two weeks after starting anticoagulants.
Rest as much as you can.
By following some basic steps you can prevent blood clots. However, after delivery, there are some symptoms that could indicate some issue.
When To Call The Doctor?
If you notice any of the following symptoms, call your doctor immediately (1).
Fever over 100.4 degree fahrenheit with severe chills.
A blood flow that needs you to change the pad per hour.
Large size blood clots: If you continue to pass large size blood clots after the first 24 hours of delivery, following heavy blood loss.
Heavy blood flow: The blood flow should reduce gradually as the week passes. If it does not, call the doctor.
Foul smell: If the vaginal discharge has an offensive odor, which could be due to an infection of the uterus or the perineum.
Pelvic pain: A urinary infection, infection of the uterus, or constipation can cause pelvic pain.
Other important symptoms such as: Blurred vision, severe headache and fainting, chills, rapid heartbeat, weakness, dizziness, swelling around the pelvic area or in the leg and difficulty breathing.
Timely diagnosis, treatment and prevention can possibly help you get through any serious risks that blood clots pose.
Does C-Section Increase The Risk Of Blood Clots?
Recent studies revealed that women undergoing a c-section were at a higher risk of developing dangerous postpartum blood clots compared to those who delivered vaginally. The risk was especially high in cases of an emergency c-section (12). According to Dr. Marc Blondon, of Geneva University Hospital in Switzerland, there is an increase in the blood’s susceptibility to clotting during surgery. Thus, women who are considered for a c-section without any medical indication for it, are at higher risks. However, the risk remains low in the majority of women who had undergone a c-section. The American College of Obstetricians and Gynecologists says that for women with no risks of a blood clot, a pneumatic compression device should be used before delivery. This helps reduce any potential risks. This device is placed on the legs to prevent blood from pooling inside the calves (13) If you have delivered recently, stay informed about the changes in your body. If you notice anything unusual, there is no harm to consult a doctor. Getting the clots treated on time, with the right medications can keep you away from possible life-threatening complications they might lead to. Do you have any experience to share with us? Let us know in the comments section below.
