"In a Revolution"

Alert Varicose Veins in Pregnant Women

In Medical Sciences on February 19, 2011 at 2:25 pm


Look at the picture! What are in your mind? Are there in your mind that it is a varicose veins complication?

Varicose Veins and Pregnancy
Varices refers to distended veins. In this time, I will share about varicose veins in related to pregnancy. Why can the pregnancy cause varicose veins?
There are some theories tell about this :
1. Mechanical theory
Lower limbs varicose disease would be caused by mechanic compression exerted by the pregnant uterus on pelvic and iliac veins. Clinical evidence has shown that venous dilatations begin their development in the first weeks of pregnancy, when the increase in uterine volume is still insignificant. Uterine tumors of a similar or even higher volume than that of the pregnant uterus do not provoke the formation of varicose veins, neither an increase in pre-existing varicose veins’ intensity. There is evidence, however, of mechanic compression of the uterus on the iliac veins and inferior vena cava, especially in the last trimester of pregnancy.
Through a duplex scanning, phlebography and even computed tomography, it was demonstrated that the speed of blood flow in femoral veins progressively decreases, proportionally to the increase of the uterine volume, until diminishing in 50% in the third trimester.

Let me show the veins anatomy in our body! Look at the picture below!


Figure I


Figure II


Figure III

The figure I is the illustration when the abdomen is opened and all abdominal organs removed. We can look on figure II both of blood vessels in the abdomen cavity and let’s focus on pelvis veins (blue color which is a branching). Then look on figure II pelvis veins has continued into limb veins. On figure III it is clearly show the limb veins and can be seen the varicose veins too.
The maximum dilatation of the veins of the limbs of the women occurred at 37–40 weeks gestation. On the research, C. Sparey,et.al told that the results of this study were comparable with those from our group of normal women in that both groups showed increasing venous dilatation with gestational age, reaching a maximum at term and returning to baseline in the puerperium. In general, changes occurred, in the same veins and at the same sites, although there was more of a left-sided predominance in those with pre-existing venous disease. This may in some way reflect the anatomy of the vessels in the pelvis where the right common iliac artery This crosses
the left common iliac vein.
2. Hormonal theory
In 1943 by McLennam has compared the measures of antecubital and femoral venous pressure in pregnant women in dorsal decubitus and observed a progressive increase in femoral pressures, while antecubital venous pressures remained unchanged even in the initial stages of pregnancy. These alterations in venous pressure would be caused by hormonal increase, both estrogenic and progestogenic. Progesterone increase results in hypotonia of smooth muscle fibers and myocells (joint muscle framework of the venous wall), reducing excitability, electric activity and increasing venous distensibility, which reaches up to 150%, returning to normal values in 8 to 12 weeks after delivery. On its turn, estrogenic secretion causes an increase in arterial flow in uterus and pelvis, and this increment in the venous return flow toward hypogastric venous system would cause a functional obstacle in external iliac veins, transmitted to lower limbs veins.

3. Increase in pelvic circulation
In pregnancy, there is an increase in uterine blood debit (500 ml/min of total blood flow), resulting in an addition to pelvic venous pressure and venous engorgement of iliac veins and reduction in draining capacity of lower extremities’ collecting veins.

4. Hereditary predisposition

5. Increase in volemia
Blood volume during pregnancy is increased in more than 30%; this occurs mainly due to plasma activity.

6. Mesodermic deficiency
Congenital mesodermic deficiency is an important factor in etiopathogeny of essential varicose disease.

7. Structural alterations of the venous wall
There is a reduction of smooth muscle fibers of the venous wall and qualitative and quantitative alterations of the joint tissue in the wall of the varicose vein.

8. Venous valve anatomic alterations
Through agenesis or hypoplasia of the iliac-femoral valve, which supports the hydrostatic pressure of a blood column from the heart to the inguinal region.

How About the Treatment?

Surgical Treatment
1) Ablative surgery
This heading comprises surgery for stripping the saphena – “crossectomy” – at the sapheno-femoral junction, and phlebectomy.

 

2) Conservative surgery

Saphenous flow can be directed physiologically (sapheno-femoral external valvuloplasty and first step of the CHIVA 2 (Conservatrice Hémodynamique de l’Insuffisance Veineuse en Ambulatoire) strategy – see below) or reversed and directed towards the re-entering perforating vein (CHIVA 1).

 

3) Endovascular obliteration
Either chemical or physical methods can be used to obliterate the saphenous lumen.

 

Sclerotherapy
Sclerotherapy is the chemical obliteration of varicose veins. The veins are injected with a histo-lesive substance (sclerosing liquid) which damages the endothelium, producing spasm, thrombosis and an inflammatory reaction which are intended to produce stenosis, fibrosis and the permanent obliteration of the vein.

 

Compression

Compression is the pressure applied to a limb, using a variety of materials, elastic or rigid, to prevent and treat diseases of the venous or lymphatic systems.

 

Drug Therapy
Drugs for the venous system were initially called phlebotonics as they were believed to act on venous tone.

 

Physiotherapy


Hydrotherapy

How About The Prevention?

There’s no way to completely prevent varicose veins. But improving your circulation and muscle tone can reduce your risk of developing varicose veins :
 Exercising
 Watching your weight
 Eating a high-fiber, low-salt diet
 Avoiding high heels and tight hosiery
 Elevating your legs
 Changing your sitting or standing position regularly

Written by Catherine Maname Uli

 

The references :
1. Pregnancy and Lower Limb Varicose Veins: Prevalence and Risk Factors. Available from the URL: http://www.scielo.br/scielo.php?pid=S167754492010000200004&script=sci_arttext&tlng=en
2. The Effect of Pregnancy on the Lower-limb Venous System of Women with Varicose Veins. Available from the URL: http://download.journals.elsevierhealth.com/pdfs/journals/1078-5884/PIIS1078588499908705.pdf
3. Guidelines for the diagnosis and therapy of the vein and lymphatic disorders. Available from the URL : http://www.flebologia.unisi.it/lineeguida/guidelines-inglese-rev.htm
4. Varicose Veins. Available from the URL : http://www.mayoclinic.com/health/varicoseveins/DS00256/DSECTION=prevention

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