VARICOSE VEINS AND PREGNANCY

 

Pregnancy is one of the most important acquired risk factors for varicose veins. This is because on the one hand, the hormones secreted during pregnancy reduce the tone of the veins, causing them to expand, while on the other hand, the growing fetus in the uterus compresses the main vein in the abdomen which is called "Vena Cava". Because of these two mechanisms, venous insufficiency and varicose veins may occur in individuals with genetic predisposition during pregnancy. If there is venous insufficiency or varicose veins before pregnancy, venous insufficiency is exacerbated during pregnancy and existing varices may become much larger.

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Pregnancy and genital varices

Pregnancy is the most important cause of "pelvic" venous insufficiency, which is very common especially in the middle east and Africa. In this type of venous insufficiency, reflux occurs in the veins around the uterus, most commonly in the left ovarian vein, and as a result large varices occur around the uterus, ovaries and vagina. Varices around the uterus and ovaries are not visible from the outside, but can be easily detected by transvaginal color Doppler ultrasound. Varicose veins around the vagina are visible and may extend from the inner part of the groin to the legs. Pelvic venous insufficiency and some of the vaginal varices regress after birth, so patients should be evaluated with color Doppler ultrasound at least 6 months after delivery and treatment decision should be made according to this examination.

 

Pregnancy and venous thrombosis

Another common venous problem in pregnancy is the thrombosis. The aforementioned factors that cause varicose veins and venous insufficiency during pregnancy also help in the formation of venous thrombosis. Very slow blood flow in large varices protruding from the skin may also trigger clot formation. When these two factors are combined, clot formation (superficial vein thrombosis) is common in varicose veins or major superficial veins during pregnancy.

 

Superficial vein thrombosis can cause serious problems in a pregnant woman:

1. Rarely, the clot can go to the lung and pose a life-threatening risk (pulmonary embolism).

2. Pain, stiffness and redness due to inflammation in the clotted vessel may occur and may cause serious discomfort to the patient.

3. Blood-thinning medications used to dissolve the clot may pose a risk of bleeding for the fetus and mother in a pregnant woman whose birth is approaching.

4. Clot in the main vessels and varicose veins may prevent the application of effective treatments such as laser and foam. Therefore, coagulated vessels may not be treated by these novel methods.

 

 

 

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Should varicose veins be treated before or after pregnancy?

For the aforementioned reasons, it is recommended that women planning to become pregnant should have a color Doppler ultrasound if varicose veins are present in their legs. If they have venous insufficiency on color Doppler, they should be treated before pregnancy. In patients who has varices during pregnancy, it will be appropriate to examine the varicose veins with color Doppler and to use blood thinning medications to prevent venous thrombosis. In such patients, we recommend that Doppler ultrasound be repeated 6 months after pregnancy and treatment should be planned if venous insufficiency persists.