Klinika Flebologii | leczenie żył | flebolog | Warszawa / Phlebology Clinic

Disease description

There is a number of reasons of venous system insufficiency in pregnancy. In the first trimester, when uterus is not so large, hormonal changes have the most negative impact on the function of venous system, especially within estrogen and progesterone balance. In the next pregnancy weeks, increased amount of blood circulating in vascular placenta is of importance, especially in venous system, which collects 80% of circulating blood.

The last trimester of pregnancy is frequently predominated by mechanical effect. Depending on its placement and location of foetus, monumentally enlarged uterus may press inferior vena cava and iliac veins to a different extent.

The lack of venous valves in the area of ovarian veins and iliac veins is an important issue for a woman who is pregnant for the second or third time. The problem of insufficiency of the left ovarian vein (the most common in pregnant women) results from the lack of valves in this region (up to 15% of population) or defective mechanism of their closure. The lack of valves in iliac veins is nearly a constant (up to 90% of patients). In such cases, any pressure on venous flow results in nearly immediate appearance of varicose veins in intimate area.

Currently, more families take advantage of in vitro fertilization. Such method is associated with a higher exposure of females to hormonal stimulation and increased probability of having multiple pregnancy, which especially predispose to venous insufficiency of pelvis and lower extremities. Varicose veins in intimate area appearing at the end of the second trimester suggest that this problem is present and it should be verified 3 months following the child birth at the earliest.

Pregnancy is also a period of increased blood coagulability, being present at the end of the second month of pregnancy. Then, fibrinogen increases while the concentration of AT-III and protein S decreases. It should not be forgotten that long-term immobilization, lack of physical activity, drinking of small amount of liquids are important factors increasing the risk of thrombosis.

Our offer includes:

professional selection of compression therapy in pregnancy (high quality materials by Juzo, Sigvaris and Medi)
modern and minimally invasive approach to the treatment of pelvic venous insufficiency and varicose veins in intimate area (intravascular embolization, using "sandwich")

comprehensive Doppler diagnostics of venous system in pregnancy with evaluation of legs, intimate area, small pelvis and abdominal cavity
etiological treatment of varicose veins of lower extremities appeared after the deliveries
diagnostics of venous system after the delivery in 3 T magnetic resonance by Philips

To sum up, the factors that increase the risk of varicose veins during pregnancy are:

family history of varicose veins (statistically, the risk of varicose veins in person whose one of the parents have varicose veins amounts to 42%, if both of them, this risk may be even up to 89%!)
pregnancy itself (the first pregnancy is associated with an increased risk of varicose veins while the successive pregnancies increase it additionally)
hormone therapy in pregnancy
sitting or standing lifestyle contributing to venous congestion in lower extremities
increased putting on weight and declared obesity
wearing of inadequate shoes and flat foot
floor heating system in apartment
hot baths
anatomically unfavourable system of veins in abdominal cavity and small pelvis which may be verified in imaging examinations (Doppler ultrasound)

Important issues

What are the symptoms of venous insufficiency in pregnancy?

Symptoms of venous insufficiency in pregnancy are of typical nature, however, they are much more intense. The most common symptom is swelling in the area of ankle, which affects every second female. The appearance of varicose veins in females being pregnant for the first time amounts to 20%. Swelling is usually accompanied by feeling of heaviness in limbs (especially in the evening) and limb cramps (intensified particularly in the night).

There are also situations, however, in which valve insufficiency of major trunks of the superficial venous system may be present, without their excessive dilatation, even in the first trimester of pregnancy. Such changes cause discomfort, feeling of leg heaviness and pain while walking. Females mainly complain about skin changes and varicose veins which cause discoloration of legs and ankles. Pregnancy may also lead to the appearance of haemorrhoids.

What types of venous thrombosis may appear during pregnancy?

Venous thrombosis is the most severe disease occurring during pregnancy and postpartum period.

Venous thrombosis is the most severe disease occurring during pregnancy and postpartum period. It may be present in the following forms:

superficial venous thrombosis: it is perceived as the least severe condition, however, even up to 20% of cases it is associated with deep vein thrombosis. Its typical symptom is large erythema accompanied by pain and reddening. Most often, it appears in the region of affected vein. Treatment is usually of non-invasive character. It consists in the administration of local preparations and use of compression adjusted to affected lower extremity.
deep vein thrombosis: it is estimated that its frequency may even exceed 1% of cases during pregnancy and postpartum period. Each deep vein thrombosis in pregnancy must be treated as a condition which threaten life as it may end with pulmonary embolism. Vein thrombosis in pregnancy is treated with low molecular weight heparin, the derivatives of coumarin are contraindicated. During pregnancy, compression syndromes become an important problem. Most frequently, it results from the enlargement of uterus and pressure on iliac flows. Vein thrombosis within iliac and femoral segment are definitely more frequently observed at the left side. It is associated with asymmetric anatomy and unfavourable artery-vein relations. Currently, we use methods which eliminate clots in iliac and femoral veins, in both acute (up to 2-3 weeks from its occurrence) and chronic stages (4-6 months from its occurrence). More information can be accessed in the section VEIN STENTING.
thrombosis of venous plexus of small pelvis and ovarian vein: it is an underestimated and undiagnosed type of venous thrombosis in pregnant women, especially in females with the varicose veins of ovarian and uterine plexus, giving birth for the third or fourth time, in persons with undiagnosed hypercoagulability, following deliveries with caesarean section. The most prevalent type of thrombosis in this location affects the right ovarian vein (more than 70% of cases). Heavy pain (it may imitate pain of appendicitis), increased temperature or nausea appear usually up to 2-14 days after the delivery. It is a severe condition which may end with massive pulmonary embolism.

What does mainly increase the risk of thromboembolic disease in pregnancy?

A list of the most important risk factors increasing the frequency of thromboembolic disease in pregnancy includes:

caesarean section
multiple birth
pre-eclampsia
hyperstimulation syndrome (6-fold higher risk of thrombosis)
constant immobilization
active systemic infection

Is it possible to prevent varicose vein in pregnancy?

Problem pojawiania się bądź nasilania się objawów niewydolności żylnej w ciąży uwarunkowany jest anatomicznie i podatnością żył na rozciąganie. Kobieta mająca skłonność do powstawania żylaków okolic intymnych nie jest w stanie na to bardzo wpłynąć.

Appearance or intensification of symptoms of venous insufficiency in pregnancy is mainly determined by hereditary aspects. Female who has a tendency for varicose veins in intimate area is not able to change it. However, she may undertake a range of preventive actions which decrease the risk of venous insufficiency in lower extremities and pelvis.W tym celu należy:

It is recommended to:

limit long-term sitting or standing
change habits at work (more frequent rising, walking and activating shin muscles)
avoid sun and taking hot baths or sauna, especially in sitting position
wear adequately adjusted compression materials in pregnancy (stockings or tights)
avoid lifting heavy objects, try to rest with the legs raised, more often on the left side
perform exercises activating shin
use supplements enhancing the venous circulation (e.g. phlebotrophic drugs) if ordered by physician monitoring the pregnancy.

The problem of venous insufficiency in pregnancy is much more complex than it is first appeared to be. In our practice, we very often meet with neglecting the symptoms which are not severe at the beginning. Knowledge on venous compression syndromes in pelvis or pelvic venous insufficiency associated with varicose veins in intimate area is still poor in physicians. Thus, the physicians of the team of the Clinic of Phlebology have started the initiative aimed at propagating the knowledge on risks of the venous system and possibilities of its elimination in future mothers.

Methods of treatment

Planowanie ciąży a niewydolność żylna kończyn dolnych

Żylaki widoczne przed ciążą są jeszcze większym wyzwaniem. Dzięki nowoczesnym i wyjątkowo skutecznym metodom ich leczenia, takimi jak laser wewnątrzżylny nowej generacji (ELVeS 1470) czy klejenie żylaków, możliwe jest ich skuteczne leczenie na etapie planowania pierwszej ciąży czy każdej następnej.

Summary

each successive pregnancy may be a reason of venous insufficiency of lower extremities and small pelvis
pelvic venous insufficiency combined with the symptoms of pelvic congestion syndrome is a hard to diagnose disease which occurs most frequently after 2-3 deliveries
iliac and femoral thrombosis, more often left-side one, is one of the most severe form of venous thrombosis

FAQ