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Pregnant. Tiny blood vessels appeared on face while giving pressure. Will this be worse during delivery?

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Practicing since : 2006
Answered : 2015 Questions
Hi, I have this condition where the tiny blood vessels on my face break if I push too hard (for example if I have constipation and I have to push a little bit because of that). The little blood vessels break and form dark dots, some of them small and some of them a bit bigger i.e. few dots merge into one. These dots are very flat to the surface i.e. there are no bumps. If you touch them, you would not feel any bumpiness. Also, there is no redness or flushing ever, the dots only come on when I push, usually for the bathroom. They only come on my face, mostly cheeks, chin, neck and a little bit around the collar bone. There could be some on the foreheard too. These dark red dots go away after a few days on their own. I even know pretty much how hard I need to push for that to happen and if I push lighter than a certain level, they do not appear.
I am 27 weeks pregnant now and concerned that the pushing required for labor could lead to bigger blood vessels on my face bursting where I could even have a stroke. My grandfather had a stroke, but he did not have my condition. Therefore my obgyn is offering c-section but I was advised to consult with a dermatologist. Have you seen this condition happen before and would you know what it is and how is it impacted by labor? Thanks

Posted Sat, 23 Mar 2013 in Skin Hair and Nails
Answered by Dr. Kalpana Pathak 26 hours later
Thanks for writing to us.
You seem to be developing petechiae on face which are basically tiny reddish purple spots that develop from superficial capillary haemorrhage. This can occur due to trauma in form of exerting too much pressure( violent coughing, sneezing, pressure during defecation or vomiting). The chances of petechial rash increases in pregnancy as the blood volume increases and platelet count falls . It is likely that you will develop such spots during labour. However these are practically harmless and chances of stroke etc aren't there as it occurs due to rupture of arteries while petechiae is due to rupture of capillary which is the finest blood vessel. Arteries do not rupture usually on exerting pressure during defecation in healthy individual. I would advise you to take high fibre diet, roughage etc and if required stool softeners so that constipation doesn't lead to such rashim your case

I would recommend that you XXXXXXX your dermatologist and get investigated to rule out any other cause for such rash( infections, drugs, clotting factor abnormality etc). You should get your platelet count, prothrombin time, clotting time bleeding time etc evaluated to look for any gross change in the same

The choice for a c section is completely yours as development of petechiae during labour due to too much pressure exertion is not an indication for a c section.
However still I would advise you to go by your gynaecologist's and dermatologist's opinion as they are in better position to assess you clinically and offer expert opinion

Hope that answers your query. Should there be more feel free to write back.
Take care.
Above answer was peer-reviewed by
Follow-up: Pregnant. Tiny blood vessels appeared on face while giving pressure. Will this be worse during delivery? 14 minutes later
Thank you very much doctor, this is extremely helpful. I never had anyone else being able to diagnose this before for me. I know my platelets count is normal - I have tested it many times as part of my pregnancy in the last 6 months and it has always came up normal. When I got it in the past I did not take any drugs or did not know of having any infections and I have never taken any blood thinning medications. But maybe I can check my vitamin K in the meantime until I see a dermatologist?
Thanks very much for confirming on the C-section. So if my capillaries are weak and they break due to pressure, it does not mean that my arteries are weak right? It's just that labor requires a lot more intense pushing than I have ever done in my life, so I was scared that maybe my blood vessels are weak and something could happen, but now I know it's safe. Is there anything I can do before labor to prevent petechiae from showing up during labor, or nothing can be done? I am seeing a dermatologist on april 11, but was wondering if you could give me advice in the meantime. Thanks!!!! Again, this was very helpful, I think you diagnosed my condition right on!
Answered by Dr. Kalpana Pathak 6 hours later
Thanks for writing back.
Capillaries are the thinnest blood vessels and are quite fragile and hence can rupture on pressure exertion during violent cough, vomit, sneeze or defecation but arteries are strong walled and can rupture only if their wall is weak due to aneurysm or if somebody has a high blood pressure. So personally I do not think you are at any risk as far as stroke or serious life threatening haemorrhage is concerned as you have not mentioned any such history.

Unfortunately nothing much can be done to prevent petechiae formation during pressure exertion. So chances are during normal labour you might have petechial rashes. Having said that I would advise you to take food XXXXXXX in vitamin c like berries, oranges, red pepper, guava etc as vitamin c has a role in collagen production and collagen has a preventive action in blood vessel fragility. Do not take synthetic vitamin c supplements as you are pregnant.
In the meanwhile consult your gynaecologist to prescribe medicines if required for constipation as too much pushing for defecation can be harmful in pregnancy. Do little bit of walking and take high roughage diet, fruits, salads and water to avoid constipation.
Do visit your dermatologist once to discuss your concern face to face and proper clinical examination.
Hope that answers your query.
Take care.
Above answer was peer-reviewed by
Follow-up: Pregnant. Tiny blood vessels appeared on face while giving pressure. Will this be worse during delivery? 1 hour later
Thank you very much doctor, actually I do not have constipation now, that was mainly before I was pregnant. My pregnancy vitamins have magnesium and it seems to help with the constipation. However, my grandfather had a stroke, actually I think he had two strokes. However I had never had aneurysm or stroke and my blood pressure is always low - 90/60 and now that I am pregnant it's about 100/70 but still low. So I guess that means I am low risk, correct? I guess it means I will have a lot of petechiae during labor but nothing serious...what if too many capillaries break even though they are tiny? Or that does not matter?
Finally, should I take a vitamin K supplement as well? I will take citrus fruits, I already eat some, but I will eat some more. Thanks! And I will see my dermatologist in a month. It's just that my obgyn needed me to decide on the C-section by next week so I needed to sort this out now i.e. the dermatologist is too busy and cannot see me now, so I needed to make this decision without seeing him. Thanks again.
Answered by Dr. Kalpana Pathak 2 hours later
Thanks for writing back.
Developing petechiae is seen in many females during normal labour. It is not necessary that you will develop too many rashes during labour. If pushing during labour is done properly you may or may not get these rashes. So do not worry about it right now. Petechiae due to pressure exertion are harmless. I do not see any correlation in petechiae and stroke.
Do not take vitamin k supplement unless you know you are deficient in the same. Just keep your diet balanced and healthy.
You are still far away from full term. Just because of petechiae I personally do not see any point in going for elective c section. However what is your obstetrician's clinical view point regarding this issue holds utmost importance as she is the one who has assessed you clinically and she must have seen pregnant females developing such pin point rashes during labour more commonly than a dermatologist. Kindly discuss the issue in detail with her and follow her clinical advise.
Hope that helps. I shall be available for follow up, so if there is any doubt feel free to write back.
Above answer was peer-reviewed by
Follow-up: Pregnant. Tiny blood vessels appeared on face while giving pressure. Will this be worse during delivery? 4 hours later
Hi Doctor, thanks! Actually my obgyn does not insist on a c-section, he just gave me the option. I guess he is ok either way how I have my child and just wants me to be comfortable with what I choose. Also, I have had a lot of blood tests lately and I never had any problems with blood not stopping properly after it was drawn etc. Also, I had some other surgeries and again never had any blood issues. So you are right, I guess I am in no health risk here even if I was to do labor. I can ask the dermatologist about further tests when I see him - the protrombin one etc that you suggested above, but hopefully nothing should come out of it. Thanks again for all your help!
Answered by Dr. Kalpana Pathak 9 hours later
In all probability all your blood tests would come normal. Getting an elective c section done is then completely your choice but getting these rashes should not hinder you from going for a normal vaginal delivery! XXXXXXX your dermatologist once too whenever you get an appointment.
Wish you good health. Take care.
Above answer was peer-reviewed by
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