Patient's Query
Hello doctor,
My wife delivered a baby. After delivery, she had a severe headache. An MRI scan was taken after a week. She was diagnosed with cavernous venous thrombosis in her brain and was put on medication with Warfarin. After that, she is at home. But the problem we are facing is that she has a persistent fever, and even today, 29 days after delivery. The doctors here have given her a variety of antibiotics, so she gets perspiration, and the fever fades away. The temperatures recorded range from 99 to 100.5 degrees. A blood test was done, and the RBC/WBC count was fine. We are very worried and unable to understand what the root cause of the fever is, and whether it is pointing to something serious. We remove any excess milk during breastfeeding, so we do not believe this is the cause. Also, she had a C-section operation for delivery, and the stitches have still not completely healed, but there is no pus in the stitches. She also had post-spinal complaints on the third day after delivery. There was swelling in the feet since the sixth month. It seems that during pregnancy, blood pressure was high but never detected. Now there is no swelling. Already in touch with local doctors. Looking for a second opinion.
Hi,
Welcome to icliniq.com.
I can completely understand your concern and anxiety; here in tropical countries, we get lots of female patients with CVT (cavernous vein thrombosis) almost every day because it is very common in the tropical country setup, so in general, doctors in tropical countries have vast practical and theoretical experience in dealing with such patients due to the large number of deliveries performed daily, and a large number of deliveries means a large number of patients with post-delivery CVT (cavernous vein thrombosis). But on the contrary, in European countries, it is the other way round, and the doctors there fail to manage such patients appropriately; I hope you got my point. I am saying this because after reading your query, it is very clear that the doctors are not managing your wife's case in the right manner with the right approach.
Let us discuss, and let me explain to you step by step, and I will take care to explain in as simple language as I can, rather than using complex medical and technical terms.
1. During pregnancy, there is a marked change in the physiology of the human body. For example, the functioning of the body changes a lot from the way it functions during the period, that is, when a female is not pregnant.
2. One of the major changes is that pregnancy is a prothrombotic state; that is, during pregnancy, there is a marked increase in various mechanisms that can lead to the formation of blood clots inside the normal blood vessels, and every pregnancy involves some risk of formation of blood clots anywhere through the veins in the body, and this risk is increased when there is some surgical intervention involved (cesarean section in your wife's case).
3. Nowadays, certain tests are routinely performed during pregnancy to find out the potential risks for clot formation so that specific medicines can be given to prevent this potentially dangerous complication of blood clots. I am afraid that no such tests were performed when your wife was pregnant.
4. Your wife had swelling in both legs since the sixth month of pregnancy, and now this is something shocking that the doctors failed to notice. How could they not notice? Now, various underlying disorders can lead to the development of leg swelling, and many of those are directly linked to the development of clots in the venous circulation.
So from these facts, we can now conclude why your wife developed CVT in the first place. The reasons are:
1. She was not screened properly to identify the risk factors during her pregnancy, which is a standard routine nowadays everywhere in the world; that is, identification and removal of risk factors, and following this standard routine, a large number of possible complications can be prevented from happening.
2. Her leg swelling was ignored, and no efforts were made to detect and treat the underlying cause, which has played a major role in the development of CVT in your wife after delivery.
3. A cesarean section was performed, which further increased the risk of CVT.
4. Last, and another big mistake the doctors were making is that they are not dealing with CVT in a proper way; that is the way in which it should be dealt with ideally. Let me explain this point, and you will get an answer to all your doubts in the explanation below.
CVT was not prevented, and it happened, so what should a doctor do next? The next step should be the right and precise management of CVT so that it is cured without any grave consequences. CVT is a potentially dangerous complication after delivery, and three out of ten patients die if this condition is left untreated.
The right way of approaching the management of CVT includes:
1. Detailed investigation or lab tests as soon as there are any signs of CVT after delivery (fever and severe headache in the case of your wife), explore every possibility out of a large number of factors that have led to the development of CVT. Some of these tests are:
But from the details given by you, it appears they only did MRI (magnetic resonance imaging) and WBC/RBC counts and nothing else.
2. Persistent fever even after 29 days indicates there is a source of infection that is still present inside her body, and let me tell you, it is a serious thing for sure. They should make an active and extensive effort to locate and treat that source of infection. Here is a list of tests that should be performed immediately.
3. It is strongly recommended that patients with CVT should be kept and managed in the hospital and should be given antibiotics by intravenous route rather than by oral route. The patient should not be discharged until she is cured and all the clinical signs and symptoms disappear. I wonder why they have been discharged and prescribed oral antibiotics? This is not at all the right way to treat a patient with CVT.
4. Warfarin is an anticoagulant drug, but I am again surprised why they are giving Warfarin when there are other, much better drugs available. She should have been given low molecular weight Heparin (LMWH), which is a standard drug for CVT (cavernous vein thrombosis) patients nowadays.
I hope I have provided you with all the details and information, including the explanation you asked for about her persistent fever and other things; I am sure that now you have got a clear picture of what your wife is suffering from and how it can be cured.
I will be more than happy to provide if you require any more information or have any more doubts, so please feel free to ask me anytime.
Thank you.
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