Pregnancy and varicose veins

Varicose veins are a chronic disease of the superficial veins of the lower extremities. During pregnancy, the disease progresses due to changes in the woman’s body. Pregnant women are treated under the supervision of the attending physician and phlebologist.

Causes of varicose veins in pregnant women

During pregnancy, a woman’s hormonal background changes, the body’s blood volume increases, the uterus increases in volume, and compresses the lumen of the inferior vena cava.

What happens to the body:

• The blood flow is redistributed – an additional embryonic circle of blood circulation appears;
• the venous load on the circulatory bed of the pelvis and lower extremities increases, making it difficult for the outflow of blood from the legs to the heart;
• body weight increases;
• the volume of circulating blood doubles;
• increases the load on the heart muscle;
• increased blood clotting;
• Venous blood flow slows down;
• venous vascular walls weaken under the influence of progesterone;
• Increased intravascular venous pressure (especially in the legs).

How do varicose veins develop?

Elevated progesterone, characteristic of the hormonal background of pregnancy, weakens the muscle tone of the venous wall throughout the vascular bed of the body.

The increased blood volume in blood vessels with weakened walls overflows and deforms them. Many pregnant women develop varicose veins.

Also, varicose veins are possible due to the fetus’s and uterus’s growth. When expanding, they put pressure on the large vessels of the pelvic cavity (especially on the inferior vena cava and right ovarian vein), which disrupts the outflow of venous blood to the heart. Venous congestion of the underlying sections overflows the vascular bed with blood, expanding the veins of the pelvis, genitals, groin, and lower extremities. As a result, varicose veins of the superficial system occur. At the same time, the deep system of the veins of the lower extremities does not suffer since they are located in the muscular case.

Signs of varicose veins

Most often, it all starts with visual manifestations. Vascular networks and reticular veins appear. Further, clinical symptoms join: swelling of the lower extremities by the end of the working day, heaviness, fatigue, and feeling as if the legs are on fire. Some patients experience a condition such as restless legs syndrome.

At more advanced stages, skin changes (redness, induration, soreness) can be observed along the course of varicose veins. This condition is characterized as thrombophlebitis. Trophic changes in the skin and the formation of trophic ulcers on the affected lower limb can also join.

Varicose veins of the vulva and vagina

A characteristic venous pattern appears in the genital area. Gradually varicose veins increase and swell. This makes the woman uncomfortable. If she does not go to the doctor for help, inflammation, thrombosis, and ulceration join the varicose veins.

Varicose veins in the vagina are more difficult to notice due to the similarity with the usual inflammation of the genitourinary system.

Symptoms:

• heaviness, discomfort, aching pain in the lower abdomen;
• burning sensation when urinating; itching at the entrance to the vagina after emptying the bladder;
• pain during bowel movements;
• Discomfort and pain during intercourse.

Women go to the gynecologist complaining of discomfort, soreness, or spotting during sex. On examination (vaginal examination), the doctor makes a diagnosis. He makes recommendations that must be followed.

A timely diagnosis prevents the possibility of complications. With modern treatment methods for emergency indications, a pregnant woman is relieved of vaginal varicose veins long before childbirth.

Therefore it is important :

• early registration for pregnancy;
• time to do tests;
• discuss with the attending physician changes in well-being, especially painful ones;
• do not have sexual intercourse, which is dangerous for varicose changes in the vagina and vulva.

During childbirth, varicose veins of the vaginal veins are complicated by trauma to the altered vessels, and venous bleeding opens. This becomes a serious complication in the postpartum period.

If the doctor has serious reasons to avoid such a risk, the woman is placed in a hospital shortly before the expected date of birth, and a planned cesarean section is performed.

Varicose veins of the pelvic organs: uterus, bladder, rectum, and anus (internal and external hemorrhoids)

Stagnation of venous blood in the pelvis contributes to the expansion of the veins involved in the blood supply to the uterus, bladder, rectum, and anus.

Particular attention to this type should be to existing varicose veins of the lower extremities. Do not neglect the information from the family history, indicating heredity.

Symptoms:

• severe pain;
• bleeding, spotting after sex, blood in the urine, feces mixed with fresh blood;
• varicose veins of the uterus (determined during ultrasound);
• external and internal hemorrhoids (determined during examination).

If the attending physician finds varicose veins of any localization in a pregnant woman, she is sent for a consultation and registered with a phlebologist.

What are dangerous varicose veins during pregnancy?

During pregnancy and childbirth, any pathological condition is dangerous.

Risks associated with varicose veins in pregnancy:

• Varicose changes in the pelvic organs affect the blood circulation in the “mother-fetus” system. With severe violations of the venous outflow, the placental blood flow suffers, which is dangerous for the health and life of the unborn child.
• Varicose veins of the pelvic organs are especially dangerous. In late pregnancy, the fragile walls of pathologically altered veins are damaged. Internal or vaginal bleeding occurs.
• The risk of bleeding during childbirth increases.
• With strong stress during childbirth, thrombi can break off with thrombophlebitis of any localization, which increases the risk of death.

The doctor leading the pregnancy and the phlebologist jointly develop a treatment plan.

Prevention of varicose veins and their complications during pregnancy

Key recommendations:

• Early appeal to the gynecologist, registration for pregnancy. Implementation of expert advice. Regular visits to the antenatal clinic.
• Healthy, active lifestyle: outdoor walks, Pilates for pregnant women, yoga, swimming, aqua aerobics. Refusal from saunas, baths, hot vans, and exposure to the open sun.
• Proper nutrition with enough vitamins, minerals, and fiber. Exclusion of sweet, fatty, fried, smoked, floury, starchy foods. Body weight monitoring.
• Drinking enough water.
• Rejection of bad habits.
• Loose clothing is made from natural fabrics. Refusal of shoes with heels and tight ballet flats. Wearing comfortable, soft shoes made of natural materials with a comfortable shoe and arch support.
•  Breaks during work to warm up and walk.
• Sleep on the left side, reducing the pressure of the uterus on the inferior vena cava and right ovarian vein.

This will prevent further development of varicose veins and their complications.

 Diagnostics

There are no problems with the diagnosis with damage to the superficial veins of the lower extremities, the vulva, the entrance to the vagina, and the appearance of external hemorrhoids. The doctor puts it on examination, considering the patient’s complaints and general information about the medical history.

It is more difficult to detect varicose veins in the internal organs of the small pelvis: deep hemorrhoids, vagina, uterus, and bladder. Signs:

• Dilatation of the veins of the uterus was visualized on ultrasound.
• Internal hemorrhoids, palpable with rectal finger examination.
• Vaginal varicose veins are determined during a vaginal examination.
• Damage to the bladder when the blood appears in the urine – if there are no other reasons and changes in the veins in neighboring organs.

The results of routine examinations of a pregnant woman, which are carried out by the standard protocol for managing pregnancy, are important. For example, a urine test containing blood.

A decrease in hemoglobin levels is often associated with chronic internal bleeding from damaged vessels. Elevated sugar increases the vulnerability of the vascular walls to the effects of infection.

During pregnancy, performing a Doppler ultrasound (USDG) of venous vessels is safe.

The method defines:

• the degree of development of varicose veins;
• localization and degree of deformation of the venous valves;
• the severity of the violation of the direction of blood flow through the veins (in the opposite direction from the heart down and towards the emergency collaterals);
• The presence of changes in the surrounding tissues.

Magnetic resonance imaging is performed in severe cases (with suspected spontaneous rupture of internal dilated venous vessels and bleeding).

Treatment Methods

It includes:

• wearing compression underwear;
• leg lift;
• immersion in water
• appointment of phlebotomists from the 3rd trimester
• use of local resources.

Compression stockings

Wear all day, take off at night. The stockings stably compress the legs, helping the veins and muscles of the legs to move blood. The compression ratio depends on the type and brand.

Leg raise

If you lie on your back several times during the day and raise your legs, leaning against a wall or headboard, the condition of the veins improves significantly. Especially if you combine it with walking in the fresh air, gymnastics for pregnant women, and yoga.

Immersion in water

When the legs swell, slightly warm baths with salt help, feet are immersed in a saltwater basin for 15-30 minutes. With hemorrhoids and varicose veins of the vulva, sedentary warm baths with salt or a weak solution of potassium permanganate are also prescribed.

Preventing complications is the main method of managing pregnant women with varicose veins. In case of complications, specialists carry out treatment according to the situation, taking into account the patient’s individual characteristics, general health, the severity of the course of varicose veins, and the risks associated with it.

Radical methods in pregnant women are used by doctors extremely rarely and only for health reasons (with a threat of death).