Chronic venous insufficiency and pregnancy

Chronic venous insufficiency or chronic venous diseases include varicose veins, postthrombotic disease, congenital and traumatic anomalies of venous vessels

ICD-10:

• 183 Varicose veins of lower extremities
  • 183.0 Varicose veins of lower extremities with ulcer
  • 183.1 Varicose veins of lower extremities with inflammation
  • 183.2 Varicose veins of the lower extremities with ulcer and inflammation
  • 183.9 Varicose veins of lower extremities without ulcer and inflammation
• 186.3 Varicose veins of the vulva
• 187 Other disorders of veins
  • 187.0 Post-thrombophlebitic syndrome
  • 187.1 Compression of veins
  • 187.2 Venous insufficiency (chronic) (peripheral)
  • 187.8 Other specified disorders of veins
  • 187.9 Venous lesions, unspecified
• 022 Venous complications during pregnancy
  • 022.0 Varicose veins of the lower extremities during pregnancy.

[1], [2]

Epidemiology

Epidemiology of chronic venous insufficiency in pregnancy

The incidence of chronic venous insufficiency is 7-51.4%, in women it is 62.3%, in men it is 21.8%. Chronic venous insufficiency of moderate and severe severity occurs in 10.4% of cases (in 12.1% of women and 6.3% of men), with the development of trophic ulcers in 0.48% in the population. According to different authors, chronic venous insufficiency during pregnancy affects from 7 to 35% of women, the first time during pregnancy chronic venous insufficiency develops in 80% of them.

[3], [4], [5], [6], [7], [8], [9]

Causes of the chronic venous insufficiency in pregnancy

Causes of chronic venous insufficiency

The main etiological factors in the development of chronic venous insufficiency outside of pregnancy include:

• weakness of the vascular wall, including connective tissue and smooth musculature;
• dysfunction and damage to the endothelium of veins;
• damage to the venous valves;
• disturbance of microcirculation.

In the presence of these factors, their aggravation occurs during pregnancy.

Chronic venous insufficiency in pregnancy - Causes

[10], [11], [12], [13]

Symptoms of the chronic venous insufficiency in pregnancy

Symptoms of chronic venous insufficiency in pregnancy

Clinical classification is based on objective clinical signs of chronic venous insufficiency (C0-6) with the addition of: A - for asymptomatic disease course or C - for symptomatic. Symptoms include: pulling, aching pain, heaviness in the lower extremities, trophic skin disorders, convulsive twitching of the leg muscles and other symptoms inherent in venous dysfunction. The clinical classification is made upward as the severity of the disease increases. Limbs with a higher score have significantly more severe manifestations of chronic venous disease and may have some or all of the symptoms characteristic of a lower category. Therapy and some conditions (for example, pregnancy) can change clinical symptoms, and then the condition of the limb should be overestimated.

Chronic venous insufficiency and pregnancy - Symptoms

Diagnostics of the chronic venous insufficiency in pregnancy

Diagnosis of chronic venous insufficiency in pregnancy

Investigations of veins in pregnant women with chronic venous insufficiency are performed using sensors with frequencies of 8 MHz (posterior tibial vein, large and small saphenous veins) and 4 MHz (femoral and popliteal veins).

The Doppler study is performed to establish:

• permeability of deep venous system;
• Validity of valves;
• localization of reflux sites in perforating veins and anastomosis;
• determining the presence and localization of thrombi.

Compression tests are used to assess not only the patency of deep veins, but also the consistency of valves of deep, subcutaneous and perforating veins. Normally, during proximal compression and distal decompression, the flow in the veins of the legs stops.

Chronic venous insufficiency and pregnancy - Diagnosis

[14], [15], [16], [17], [18]

Treatment of the chronic venous insufficiency in pregnancy

Treatment of chronic venous insufficiency

The most modern method of non-specific prophylaxis and treatment of chronic venous insufficiency during pregnancy is the use of special compressive knitwear of the 1st and 2nd compression class, including the hospital one. The conducted studies of the effectiveness of therapeutic knitwear of the 1st and 2nd compression classes during pregnancy and in the postpartum period have shown that its use during pregnancy, childbirth and the postpartum period promotes the acceleration of venous blood flow in the lower extremities and improves the subjective feelings of patients. According to ultrasound in patients who used products from therapeutic knitted fabric of the 1st and 2nd compression class, there was a more pronounced decrease in the diameter of venous trunks in the postpartum period.

Compression knitwear for patients should be used daily throughout pregnancy and in the postpartum period, for at least 4-6 months.

Chronic venous insufficiency and pregnancy - Treatment