Pregnancy and delivery complications can range from mild to life threatening for the mother, baby, or both. One of the most severe complications is a pulmonary embolism, a condition where a blood clot blocks an artery in the lung. Pulmonary embolisms (PE) typically occur during or shortly after the labor and delivery, and may be fatal for the mother if not treated immediately.
PE is a leading cause of maternal deaths in developed countries, and the unfortunate reality is that the US has one of the highest maternal mortality rates of all industrialized nations. In 2015, the rate was 25.1 deaths per 100,000 live births. In the US, PE causes 20 percent of maternal deaths.
Dr. Amos Grunebaum, a high-risk pregnancy specialist at Weill Cornell Medicine, seeks to educate women, including his patients, about this condition. He hopes to raise awareness about this rare, but very serious condition, and also help women learn to advocate for themselves.
“The US has a highly diverse population, and significant portions of the population do not have access to adequate prenatal care,” says Dr. Grunebaum. “This is one of the reasons why we have a higher maternal mortality rate than other countries.”
Women with a history of blood clots, varicose veins, or deep vein thrombosis are at a higher risk than normal for a pulmonary embolism while pregnant.
“One of the best things that expectant mothers can do to protect themselves,” says Dr. Grunebaum, “is ask their family members about any history of pulmonary embolisms, blood clots, and deep vein thrombosis. Be sure to tell your gynecologist about any family history.”
The second major risk factor for pulmonary embolism is the mother’s weight, both during pregnancy and at the time of the birth. Women with a BMI over 30 have an increased risk for pulmonary embolism. Women with a BMI over 40 are at an even higher risk.
In addition, irritable bowel syndrome (which increases your overall likelihood of developing blood clots) is another factor. Twin pregnancies and Cesarean-section deliveries also create an increased risk, but proper management can help mitigate this risk.
“If you think that there’s a greater chance that you may have this condition,” says Dr. Grunebaum, “it’s important to see a high-risk obstetrician as soon as possible to be sure that you’re receiving expert care.”
It is difficult to detect PE in pregnant women because the circulatory system changes considerably throughout pregnancy. The most common symptoms — shortness of breath, chest pain, and leg swelling — are also general pregnancy symptoms, which makes it difficult to discern if the symptom is the result of a PE or not.
To diagnose PE, obstetricians rely heavily upon patient history and general health to assess whether or not a patient has a suspected embolism. Diagnostic imaging (CT, MRI, or ultrasound), blood tests, or other tests are then performed to detect and confirm the presence of a blood clot.
In general, pregnant women with PE receive heparin, a type of blood thinner, to help decrease the blood’s ability to clot. In emergency situations, thrombolytics are given to break up blood clots.
At Weill Cornell Medicine, additional steps are taken to help prevent blood clots from forming in the first place for pregnant women and women who have just given birth. These three practices are now standard:
“These practices are now standard at Weill Cornell and Columbia hospitals here in New York City,” explains Dr. Grunebaum. “They are examples for the entire country, and many other hospitals are following these standards because of our success rates.”
Dr. Grunebaum stresses how important it is for women to take care of themselves before getting pregnant, including making adjustments to diet and exercise regimen, and achieving an ideal weight.
“I often joke,” says Dr. Grunebaum, “that we take better care of our cars before we go on vacation than our bodies before we get pregnant. We make sure to change the fluids and fill up the gas tank. Women should do the same thing before becoming pregnant. You should be eating well, drinking enough water, and exercising. Schedule a preconception appointment with your gynecologist to be sure you’re in good health.”
It’s best for women to get pregnant while at a healthy weight; this is one of the best ways to prevent blood clots and PE.
“If possible, try to get your BMI somewhere between 18.5 and 25 before trying to conceive,” advises Dr. Grunebaum. “Once you become pregnant, gain only the recommended amount of weight throughout your pregnancy.”
All pregnant women can take steps to prevent and protect themselves from PE. One of the most critical steps is to deliver your baby in a hospital or a birthing center within a hospital. A hospital is the safest place for mothers and babies in the event of an emergency, including a PE. In addition, pregnant women should try to exercise and walk as often as possible to help prevent blood clots from forming.
After giving birth, it’s beneficial to get up and out of bed as soon as possible to promote good circulation. For women who deliver via Cesarean section, this is especially important. “If you have a Cesarean section,” says Dr. Grunebaum, “ask to wear compression socks and get out of bed early and often.”
PE during and after pregnancy is a dangerous condition—but the good news is that expert and early prenatal care can help prevent and manage blood clots and any related complications.