PREGNANCY AND VEINS

Pregnancy has significant changes on the venous system. The hormonal and blood volume changes associated with the pregant state affect the venous walls of veins, and predispose women to numerous vein problems, ranging from phlebitis to DVT, varicose veins, and pelvic congestion syndrome

WHAT PROBLEMS ARE ASSOCIATED WITH VEINS AND PREGNANCY?

The typical scenario of vein problems associated with the pregnant state is the increasing number of painful varicose veins that seem to spontaneously appear and enlarge throughout the 9 months. Typically, the veins are in the calf areas and thighs, although some women develop veins in the vaginal walls and vulva that can be alarmingly large. These vaginal and vulvar vein enlargement can be quite painful and can significantly affect one's normal routine. Phlebitis has a higher risk of occuring during the pregancy, and presents as a hard, red mass or line under the skin at the site of a previous varicose vein. These episodes are usually self-limited, and resolve with time, elevation, non-steroidal anti-inflammatory agents, and sometimes antibiotics, depending in the degree of inflammation. Phlebitis can be repetative and annoying during this time period. In the event that one has phlebitis during pregnancy, it is a good idea to have a venous Doppler ultrasound to make sure there is no evidence for an underlying deep venous thrombosis (DVT).

Deep venous thrombosis tends to present as unilateral swelling accompanied by pain. Sometimes, patients will have significant swelling due to the fact that the uterus expands with the baby and compreses the main vein draining the legs, the inferior vena cava (IVC). In the event of swelling of the legs, a Doppler ultrasound is a simple test to perform to make sure that there is no evidence for a DVT. If a DVT is present, then blood thinning with injections of Lovenox is indicated for the rest of the pregnancy and 4-6 weeks after pregnancy to try and prevent a pulmonary embolus. Lovenox is not indicated in pregnant women who have prosthetic heart valves. Warfarin (Coumadin) is contraindicated during pregnancy because it does cross the placenta into the babies circulation and can cause birth defects. It can be used after delivery since it does not cross into breast milk. If one has a DVT during pregnancy, one has a high risk for recurrent DVT in subsequent pregnancies, and prophylcatic blood thinning might be indicated.

HOW DO I PREVENT VEIN PROBLEMS DURING PREGNANCY?

It might not be possible to completely prevent varicose veins or other venous complications during pregnancy, but one can reduce the risk for these problems. It is recommended that one exercise regularly but walking for 20 minute a day. If one carries more weight than is recommended, then the veins have to work harder, and therefore are more prone to developing problems. Elevation of the legs above the waist level if possible will help to return blood back towards the heart. Wearing compression stockings throughout the pregnancy helps to keep the veins decompressed, and increases the blood flow back to the heart. There are even maternity compression garments that take into account the expanding uterus. Sleep on your left side with your feet on a pillow. Wedge a pillow behind your back to keep yourself tilted to the left. Since the inferior vena cava is on the right side, lying on your left side relieves the vein of the weight of the uterus, thus decreasing pressure on the veins in your legs and feet. When one sleeps, try sleeping with with the left side down with a pillow between the legs, since this position tends to move the uterus off the vena cava.

WHATS THE LONG-TERM OUTLOOK WITH VEINS DURING PREGNANCY?

Even the largest vulvar veins will improve after the baby is born, and one loses weight. The same improvement generally occurs for leg veins, although these changes will not all go away. If further pregnancies are anticipated, it is better to wait until surgical treatment until one has finished bearing children.

WHAT IS PELVIC CONGESTION SYNDROME?

Pelvic congestion syndrome is a condition of enlarged veins in the pelvic floor. Patients typically complain of heaviness and aching in the deep seated pelvic area, sometimes worse during the menstrual cycle. Intercourse can be painful, and the mentrual cycle might also be irregular or heavy. The underlying etiology of the condition is a faulty valve machinsm in the pelvic veins, specifically the veins from the ovaries that leads to backflow of blood into the pelvic floor. Testing with MRI or ultrasound scans will show enlarged veins in the pelvic. Sometimes, the finding is made during laparoscopy for an unrelated problem. Depending on the severity of the symptoms, the veins can be treated from the inside by access from the groin veins. By injecting X-ray dye into the pelvic veins and diagnosing the source of the leaking valve, the interventionalist can place coils or other material into the veins to decompress the pelvic veins and prevent the backflow of blood. To find out more information about pelvic congestion syndrome, please the Society of Interventional Radiology website by clicking on this link