Varicose veins in pregnancy

According to obstetricians and gynecologists, varicose veins during pregnancy are observed in 55% of women carrying a child. Violation of venous circulation worries expectant mothers and raises many questions.

We will try to answer them, but our conversation today will be devoted to varicose veins on the legs, since detailed material “Varicose veins of the vagina and external genitalia in pregnant women” has already been published on our portal (you can follow the link).

Causes of Varicose Veins During Pregnancy

Doctors explain the causes of varicose veins during pregnancy by a genetic predisposition to weakening of the tone of the vein walls or insufficiency of the venous valves, as well as by the peculiarities of the physiological state of the woman's body during this period.

Ascending venous blood flow from the lower extremities – in defiance of gravity – is ensured by muscle contractions acting on the vein walls (the so-called muscular venous pump) and venous valves, the function of which is to prevent the backflow of blood. When the venous walls are weak, the vessels stretch, while the lumens of the vessels expand, and the valves are not able to completely close them. This leads to an increase in blood pressure in the veins of the legs, and varicose veins occur. Therefore, if women in the family suffer from this chronic pathology, a pregnant woman is unlikely to be able to avoid this diagnosis.

But the genetic factor only creates the prerequisites for the manifestation of varicose veins during pregnancy, and the key reasons are hormonal changes and some systemic changes characteristic of this condition. Firstly, the hematopoietic system in pregnant women works to increase the volume of blood in the vessels. This is the so-called physiologically conditioned, that is, necessary for the normal development of pregnancy hypervolemia. As a result, by the end of the gestational period, the volume of circulating blood increases by 32-35%. And, naturally, this increases the pressure on the blood vessels - especially on the veins of the legs.

Secondly, elevated levels of progesterone in pregnant women, as well as the hormone relaxin synthesized by the ovaries and placenta in the process of preparing the body for childbirth, cause relaxation of not only the ligaments of the joints and muscle fibers of the skeleton, but also the smooth muscles of the vessels - including the walls of the veins. And here again everything comes down to the fact that the venous valves do not cope with their functions.

And finally, do not forget that the growing fetus and the enlarging uterus exert constant and gradually increasing pressure on the venous vessels in the pelvic and abdominal area.

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Symptoms of Varicose Veins During Pregnancy

The main symptoms of varicose veins during pregnancy are that the legs quickly get tired when walking or after a relatively short period of standing, and become “heavy”. Often by the end of the day, the feet and ankle area swell, and over time the swelling affects the shins. Towards evening or at night, cramps in the calf muscles may occur.

Most often, women notice bluish or purple nets or "stars" under the skin that appear on the lower part of the shin, on the foot (on the instep and closer to the ankle) or on the calves. This is called telangiectasia and is an external manifestation of the expansion of the lumens of small vessels. It is also possible for individual small vessels or parts of them to show through the skin. Such vessels twist under the skin as blue veins and often swell and pulsate, protruding above the skin.

In addition, itching of the skin, burning and aching pain may be felt, which are localized along the subcutaneous veins below or above the knee, the popliteal, inferior vena cava or superficial femoral vein (on the inner side of the thigh).

Diagnosis of varicose veins during pregnancy is carried out on the basis of examination of the patient and collection of anamnesis and in most cases is not difficult. Blood tests for platelets, ultrasound of veins, Dopplerography and rheovasography are carried out on pregnant women for medical reasons - if thrombophlebitis is suspected.

Treatment of varicose veins during pregnancy

It is quite obvious that the treatment of varicose veins during pregnancy has limitations. The main method used for pregnant women is compression therapy with elastic bandages and compression hosiery (stockings, knee-highs, tights for pregnant women). Both can be purchased at pharmacies or medical equipment stores - after consulting a phlebologist who will determine the necessary level or class of compression.

As a rule, for preventive purposes, pregnant women are recommended to wear special hosiery of the 1st compression class (pressure 18-21 mm Hg), and in case of obvious varicose veins - 2nd class (22-27 mm Hg).

With the help of compression treatment it is possible to reduce the diameter of the superficial veins of the lower extremities, increase the intensity of venous blood flow and reduce blood stagnation and swelling.

Of the external medicinal products for the treatment of varicose veins during pregnancy, it is permissible to use Venoruton gel and Troxevasin ointment in the second and third trimesters.

Varicose veins that develop during pregnancy often disappear within a few months after childbirth – when the hormonal background of women stabilizes after all the changes associated with pregnancy. If the vessels in the legs do not return to normal for more than six months, you need to contact specialists - a phlebologist or vascular surgeon (for sclerotherapy or phlebectomy).

Prevention and prognosis of varicose veins during pregnancy

You can't change your genetics or hormone production during pregnancy. However, you can take steps to maintain normal venous blood flow and help prevent or reduce the effects of varicose veins.

The prevention of varicose veins during pregnancy recommended by phlebologists includes:

• night sleep and daytime rest with legs elevated - 30 degrees higher relative to the plane of the heart (it is enough to put a hard pillow under the mattress at the foot of your bed);
• during late pregnancy, try to sleep on your left side, as this will reduce the pressure on the inferior vena cava, which is located on the right side of the body;
• avoiding prolonged standing or sitting positions (body position must be changed every 30-40 minutes or 10-minute breaks must be taken);
• it is necessary to sit without crossing your legs or throwing one leg over the other;
• maximum reduction in heel height (no more than 5 cm);
• daily walks, followed by a short lie down with your legs elevated for a few minutes;
• control of weight gain (excess weight or significant weight gain in a short period of time has a particularly negative effect on the veins);
• reducing salt intake (to reduce swelling);
• sufficient intake of vitamin C, which is necessary for the synthesis of collagen and elastin - the connective tissue of blood vessels;
• constant wearing of properly selected treated compression hosiery.

As experts note, the prognosis for varicose veins during pregnancy depends on the degree of development of the pathology and individual characteristics of the course of pregnancy and childbirth. Thus, the situation is complicated by hereditary predisposition, repeated pregnancies, multiple pregnancy, difficult childbirth, age 35 or more during the first pregnancy, obesity, development of superficial thrombophlebitis.

Having varicose veins before pregnancy increases the risk that varicose veins during pregnancy can lead to blood clots and the development of postpartum deep vein thrombophlebitis.