INTRODUCTION:

Caesarean sections are getting more and more common in practice as medical expertise increases. Deep vein thrombosis in the lower limbs is one of the more frequent side effects of obstetric and gynaecological operations. Deep vein thrombosis (DVT) is a common and sometimes dangerous complication that occurs following surgery. The chances of deep vein thrombosis is 50%-70% higher.¹ In Hyderabad, Telangana, India, a prospective study was conducted to determine the prevalence of venous thromboembolism risk factors in expectant mothers.

Using a practical approach, 200 prenatal and postnatal patients were included in the study. According to the study's findings, 20% of expectant mothers had low-risk factors and 20% had intermediate-risk factors, which include immobility, ovarian hyperstimulus syndrome (OHSS), medical comorbidities, and surgical operations. Approximately 80 women (40%) had significant risk factors for the development of VTE during pregnancy and postpartum period.²

CONTRIBUTING FACTORS

The physiological changes that occur during pregnancy, the actual surgical process, and individual patient characteristics are all part of the multifactorial aetiology of DVT following LSCS.

· Hypercoagulability: To stop excessive bleeding following delivery, pregnancy naturally raises blood clotting factors. This hypercoagulable condition lasts throughout the postpartum phase, including following a caesarean section.

· Surgical Trauma: The risk of DVT can be raised by the surgery itself, which can harm blood vessels and start the clotting cascade.

· Advanced Maternal Age: Pregnancy and surgery may increase an older mother's preexisting risk of thrombosis.

· Immobility: Following a C-section, prolonged bed rest or restricted movement can impede blood flow, which can result in stasis and clot formation.

· Multiparity: Women who have been pregnant more than once may also be at an increased risk.

· Preeclampsia: This disorder can raise the risk of blood clots and is characterized by elevated blood pressure during pregnancy.

· Pre-existing thrombophilia: After a C-section, people who have inherited or acquired conditions that make them more likely to clot are at a much higher risk of developing DVT.

· Additional Risk Factors: DVT can also arise as a result of obesity, dehydration, and certain drugs.^3,4,5

PATHOPHYSIOLOGY

Three factors—venous stasis, vascular damage, and Hypercoagulability—are implicated in the development of thrombosis by Virchow's Triad, which was initially identified in 1856. Although venous stasis is the most important of the three, it doesn't seem to be enough on its own to induce thrombus formation.⁶

The aspects of Virchow's Triad are fundamentally linked to the clinical circumstances most closely associated with DVT: surgery or trauma, cancer, extended immobility, pregnancy, congestive heart failure, varicose veins, obesity, ageing, and a history of DVT.⁷

Venous thrombosis typically develops in regions where blood flow is reduced or mechanically changed, such as the pockets next to valves in the leg's deep veins. Although valves facilitate blood flow via the venous circulation, they can also be sites of hypoxia and venous stasis. The tendency for venous thrombi to develop in the sinuses next to venous valves has been shown by numerous postmortem investigations.⁸

Oxygen tension decreases as blood flow slows, and the haematocrit rises in tandem. The resulting hypercoagulable microenvironment may inhibit the expression of several antithrombotic proteins, such as thrombomodulin and endothelial protein C receptor (EPCR), which are predominantly expressed on venous valves.⁹

Additionally, Hypoxia not only inhibits key anticoagulant proteins but also stimulates the production of certain procoagulants. These include the adhesion molecule P-selectin, which draws tissue factor-containing immune cells to the endothelium. Though its exact role in this process is still up for debate, it is generally accepted that tissue factor is the principal nidus for thrombus formation, regardless of whether it is expressed by cells in the extravascular tissue or on the endothelium. Both tissue factor and P-selectin seem to be necessary for thrombus development.¹⁰

In essence, a venous thrombus consists of two parts: an exterior fibrin clot that is thick with red blood cells and an interior platelet-rich white thrombus that forms the so-called lines of Zahn. The outer scaffold, which is made up of fibrin and extracellular DNA complexed with histone proteins, may have a significant role in determining thrombus sensitivity to thrombolysis and tissue plasminogen activator (TPA). The risk of thrombus development rises with the procoagulant to anticoagulant ratio.¹¹

CLINICAL MANIFESTATION

· Throbbing pain in 1 leg (rarely both legs), usually in the calf or thigh, when walking or standing up.

· Swelling in 1 leg (rarely both legs) (Figure 1).

· Warm skin around the painful area.

· Red or darkened skin around the painful area – this may be harder to see on brown or black skin.

· Swollen veins that are hard or sore when you touch them.^12,4

Figure 1: Swelling in One Leg

DIAGNOSTIC EVALUATION:

· USG of Leg.

· Tourniquet test -A compressive tourniquet is applied to the proximal thigh and a dorsal vein in the foot is cannulated to conduct the examination. The leg's deep veins are seen by injecting contrast material and taking serial radiographs. Multiple views of a persistent filling defect are thought to be diagnostic for DVT.

· CT venography, in this a contrast media is injected into the arm and imaging is timed with opacification of the deep venous system in the lower extremities.

· MR venography provides many of the same benefits as CT venography without the need for ionizing radiation. It has a similar sensitivity and specificity for DVT.^12,11

MANAGEMENT:

This case report should prompt the doctors and nurses to establish a rapid diagnosis to provide effective treatment of DVT. It is important to be aware of DVT that can be seen after caesarean section. This report hence highlights the need for awareness regarding such conditions in obstetrics and the need for improving the competencies amongst the doctors and nurses for a multidisciplinary approach.

About the treatment modalities, anticoagulants, commonly referred to as blood thinners, are usually used following a C-section to stop the clot from growing and to lower the chance of more difficulties. With a few significant exceptions, DVT patients can be treated with oral anticoagulants alone.¹¹ Further other therapies can be used as a part of treatment are Low Molecular Weight Heparin (LMWH) or Unfractionated Heparin (UFH): These medications are utilised as a bridge medication during the acute phase, which is the first five to ten days of treatment, when a Vitamin K antagonist is anticipated. Prompt therapy initiation reduces symptoms and the risk of further thrombus formation by enhancing the body's fibrinolytic reaction and decreasing the creation of fibrin clots.¹³Direct Oral Anticoagulants vs. Vitamin K Antagonist: DOACs are a desirable alternative to VKAs like warfarin because they can be taken orally, sometimes don't require bridging, have fewer drug-drug interactions, don't require frequent laboratory monitoring, and have been shown to be just as effective as VKA therapy for DVT.^13,14Oral Rivaroxaban: Randomised controlled trials have shown that rivaroxaban, a direct factor Xa inhibitor, is equally efficacious as warfarin in treating DVT. Patients in the EINSTEIN DVT trial were randomly assigned to either rivaroxaban or LMWH/VKA treatment within 48 hours of diagnosis.¹⁵

CASE REPORT:

A 38 years old G₅P₅L₃A₀S₂T₂P₁ woman was admitted in MMMCandH at Period of Gestation 28 weeks with complaints of lower back and abdominal pain and decreased fetal movements since 1 day. She also has a history of Blood Pressure and Hypothyroidism since 1 year for this she was taking Labetalol 100mg OD and Levothyroxine 12.5mg OD. In her past obstetrical history she had two still births, this was her first pregnancy in 2007 second and third pregnancy was in 2008, 2011 and delivered baby girl in both the time vaginally without any complication, fourth pregnancy was in 2013 and its still birth cause was unknown and fifth one was preterm birth in with LSCS in 2025.Newborn baby was in NICU under ventilator support system. After 10 days of LSCS she had developed pain in her left leg calf muscle after examinations and diagnostic tests found that she is having DVT. For second Opinion she consulted cardiologist from Indira Gandhi Medical Hospital, Shimla. About her treatment injection of Heparin 200 units/kg subcutaneously for 3 days OD. After that on oral Warfarin for 1-week further Thrombophob ointment also used for topical application. Additionally, she took amoxicillin, Vitamin B12, Calcium and Iron orally. Advised her to wear stockings.

NURSING MANAGEMENT:

About nursing management, nurses needs to know about symptom management, risk factor identification, patient education, and complication monitoring these are the primary objectives of nursing care for Deep Vein Thrombosis (DVT). Nurses can assist to prevent DVT by educating patients and putting interventions like compression stockings, anticoagulation, and early mobilisation into practice.

Evaluation and Identification of Risk Factors:

· Comprehensive assessment: Nurses should look for risk factors in patients, such as prolonged immobility, diseases, and surgeries.

· Monitor for symptoms: Nurses must keep an eye out for DVT symptoms, which include pain, oedema, redness, and warmth in the afflicted limb.

· Identify and manage risk factors: Nurses should identify and manage risk factors such as smoking, obesity, and family history in order to prevent DVT.

Prevention:

· Early mobilization: Encouraging patients to move and walk, even with limited mobility, is crucial.

· Compression stockings: Graduated compression stockings can help improve venous circulation.

· Pain management: Provide analgesics for pain as needed

· Explain DVT: Educate patients about DVT, its risks, and the importance of treatment adherence.

· Self-care: Teach patients how to manage their symptoms, including elevating their legs and wearing compression stockings.

· Medication: Explain the purpose, benefits, and risks of their prescribed medications.

Nursing Diagnosis

· Ineffective tissue perfusion related to interruption of venous blood flow.

· Impaired comfort related to vascular inflammation and irritation.

· Risk for impaired physical mobility related to discomfort and safety precautions.

· Deficient knowledge regarding pathophysiology of condition related to lack of information and misinterpretation.

CONCULSION:

According to a published study, there is a chance of developing deep vein thrombosis (DVT) following a caesarean section (LSCS) however the overall prevalence in low-risk women is quite low. Although not all women undergoing caesarean sections may benefit from general medical thromboprophylaxis, it is important to evaluate each woman's unique risk variables and take preventative measures into account for those with greater risk profiles.

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Received on 15.12.2025 Revised on 10.01.2026

Accepted on 30.01.2026 Published on 25.02.2026

Available online from February 28, 2026

A and V Pub Int. J. of Nursing and Med. Res. 2026; 5(1):37-40.

DOI: 10.52711/ijnmr.2026.09

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