Gokhularam Gunasekaren

Govt medical college hospital, virudhunagar, India

Deep Vein Thrombosis (DVT) in a Postnatal Patient : A Case Report

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Biography

Gokhularam Gunasekaren is a medical graduate from Yerevan State Medical University, Armenia, where he completed his undergraduate studies in 2023 and recently finished his internship at the Government Medical College Hospital, Virudhunagar, India. During his academic journey, he developed a strong interest in uric acid therapeutics, the impact of emotional stress on the human body, and holistic approaches to disease management.

His field of interest lies in Surgical Diseases and Pediatrics, where he aspired to integrate clinical practice with research to improve patient care. He has presented and published work in related areas, which has strengthened his vision of contributing to both specialty care and community health.

Abstract

Introduction: Deep vein thrombosis (DVT) is a significant complication in the postnatal period. It occurs due to venous stasis, hypercoagulability, and vascular injury (Virchow’s triad). Pregnancy and the puerperium are hypercoagulable states, placing postnatal women at increased risk. If unrecognized, DVT may progress to pulmonary embolism (PE), a leading cause of maternal morbidity and mortality.

Case Presentation: A 38-year-old G2P2L2 woman was referred from a nearby PHC (Primary Health Center) with complaints of pain and swelling in her left leg for the past 3 days. She is on postoperative day 28 following a lower segment caesarean section. On examination, swelling, tenderness, warmth, and a positive Homan’s sign were noted in the left leg. There was no history of chest pain, palpitations, or breathlessness. No history of trauma, fever, or external bleeding was reported. There was no family history of VTE.

Past History: Not a known case of T2DM, systemic hypertension, COPD, CAD, thyroid disorders, or epilepsy.

Personal History: Mixed diet, normal bowel and bladder habits, no sleep disturbances. Obstetric History: P2L2 with permanent sterilization done. Regular menstrual cycles (4/30 days), normal flow. Attained menarche at 14 years of age.

Risk Factors

• Age >35 years, elderly gravida
• Recent caesarean section with intraoperative blood loss >1L
• Postpartum hypercoagulable state
• Decreased ambulation
• Poor hydration

Investigations

• D-Dimer: Elevated
• Doppler USG: Thrombus in left femoral and popliteal veins
• FBC: Normal
• Coagulation profile: Normal
• Echocardiogram: No evidence of intracardiac clot; normal biventricular function

Management

• Anticoagulation: Therapeutic Low molecular weight heparin prescribed for 2 weeks, followed by referral to Hematology clinic where in she was prescribed for a total 6 weeks followed by oral anticoagulants.
• Supportive care: Leg elevation, compression stockings, hydration, ambulation.
• Monitoring: Watch for signs of pulmonary embolism; serial Doppler studies.

Discussion: Postnatal women are highly vulnerable to thromboembolic events due to increased clotting factors, reduced fibrinolysis, and venous compression. Caesarean delivery increases the risk further. Early diagnosis with Doppler ultrasound and prompt initiation of anticoagulation are crucial to prevent pulmonary embolism.

Conclusion: This case emphasizes the need for a high index of suspicion for DVT/VTE in postnatal women with risk factors. Timely Doppler imaging and initiation of anticoagulation therapy significantly reduce maternal morbidity and mortality.

Prognosis and Future Risk: This patient remains at high risk of thromboembolism in future pregnancies and during any postoperative period. In subsequent pregnancies, once confirmed, prophylactic low molecular weight heparin should be initiated early and continued throughout pregnancy, extending up to 6 weeks postpartum. This is essential to prevent venous thromboembolism and maternal death.