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A.Long distance airline travel is recognised to slightly increase the risk of blood clots in the leg (deep venous thrombosis). This increase in risk is thought to be due to many factors including immobility, low cabin pressure, and dehydration. Dehydration is often encouraged by excessive consumption of alcohol and caffeine. Pregnancy itself increases the chance of developing a blood clot in the legs but the overall chance is very low as only around 1 in a 1000 pregnancies are complicated by blood clots. It is not yet known how great the risk of developing a blood clot is in pregnant women on long haul flights. However, the more risk factors a woman has for blood clots, the greater the chance of a clot forming. So it makes sense to think about this risk when travelling long distances by air. It is important to consider all the risk factors for blood clots that a woman has. The main risk factors are being very overweight, a medical condition that increases the risk of clotting, having had a blood clot before or a family history of blood clots (suggesting that there may be an inherited factor that makes the woman more likely to have a clot). The Royal College of Obstetricians and Gynaecologists in the UK have recently given some guidance about this. It is suggested that if the pregnant woman has no additional risk factors then for a flight of 3 hours or less she should simply avoid dehydration, minimise her intake of alcohol and coffee, perform calf exercises and move around the cabin where possible. For flights of over 3 hours duration she should also wear well fitting elastic below knee compression stockings. Women with additional risk factors such as having a history of blood clots or being very overweight should usually obtain specific medical advice. They may require to take specific medication to prevent clotting, especially on long haul flights, in addition to avoiding dehydration, performing calf exercises, moving around the cabin where possible and wearing well fitting below knee elastic compression stockings.

Physiotherapy prevents bladder problems after delivery

Many women are troubled by problems of urinary incontinence following vaginal delivery. While this can happen after any vaginal delivery, the chance of being affected is thought to be higher in women who have big babies or forceps deliveries. It also appears to be more common after a first vaginal delivery. Pelvic floor exercises are widely used to try and prevent this problem developing, but how effective these measures are has never been clearly established.

An Australian study set out to determine how effective pelvic floor exercises, taught by a physiotherapist, were at preventing this problem. They studied 676 women with forceps or ventouse deliveries or whose babies weighed more than 4kg. Half of these women received a 20 minute visit from a physiotherapist after delivery, where they were instructed on pelvic floor exercises and good bladder care, followed by a 30 minute home visit 8 weeks later. The other half received routine post-delivery care, where a physiotherapist did not visit. Almost 40% of the group who received routine post delivery care had urinary incontinence three months after delivery. In contrast only 31% of those women who received instruction in pelvic floor exercises reported this problem. The women who received physiotherapy visits were also more likely to be performing adequate pelvis floor exercises. This study shows that urinary incontinence is common in women with large babies or forceps deliveries, but can be prevented by good instruction on pelvic floor exercises and bladder care. Although pelvic floor exercises don’t prevent the problem in all women, they really are worthwhile.

*Reference: Chiarelli & Cockburn BMJ 2002;324:1241-1244.