Venous pathology of pregnancy

Venous pathology of pregnancy includes varicose venous, venous thrombosis, thromboembolism.

Varicose veins-the disease incidence is 20-40 % among expectant mothers. The etiology of varicose venous is explained with inherited weakness of venous vessel walls.

Varicose venous development in the first trimester is involved with hormonal changes especially with corpus corpus luteum. In the 2nd and 3rd trimester the disease developement is involved with venous vessel compression due to enlarged uterus.

At the beginning only cosmetic defect disturbs expectant mothers. But later symptoms such as fatigue, heaviness, edema, ache develops.

The treatment is compression stocking wearing. If formication disturbs the expectant mother  Gingko fort should be prescribed 1 tablet 2 times a day. The medicine strengthens venous walls, decreases its permeability and improves blood circulation.   Telangiectasia of pregnant women is included to varicose venous disease too.

Also sclerotherapy with several medicines and surgical treatment is possible but it is usually not recommended during pregnancy.

Venous thrombosis

Venous thrombosis incidence is 20.6% among pregnant women.

For venous development there must exist three main factors- they’re venous stasis, vessel wall damage, clotting factors activation.

During pregnancy and especially in the 3rd trimester venous stasis develops in the lower limbs (because of enlarged uterus). And in this period clotting factors (2nd, 7th, 8th, 10th factors and fibrinogen) level increase too. Usually vessel damage does not happen but above mentioned reasons are precondition for thrombosis.

Causes of vessel damage are inflammation, septic processes, caesarian section, age over 35 years, obesity, varicose venous, massive tissue damage (which causes thromboplastin release) , lactation decrease (especially with estrogens), oral contraceptive take  etc. 

Thrombosis usually develops in 5-6 days after childbirth. The symptoms are very nonspesific-high temperature and tachycardia. Thrombosis means that formed thrombus on a vessel wall fixed not very steadily, at any moment it can be detached and fall into blood flow.

After when secondary infection joins if the thrombus is not detached and inflammation process takes place in the thrombus. And this process is called thrombophlebitis. Thrombophlebitis has its specific symptoms- they are redness over the vessel where it is located, ache along the damaged vessel fascicule, tenderness. In this period the thrombus has less chance to detach off the vessel and flow into the blood flow.

Precise diagnosis of thrombophlebitis or thrombosis is put with contrast venography, plethysmography, impedance plethysmography, CT, MRI, US.

Pelvic vein thrombosis symptoms are- pelvic and lumbar pain spreading to the external genital organs, swollen external genital organs, bloody excretion, painful uterus during palpation. Symptoms develop very sudden during thromboembolism of lung vessels. They are sudden breathlessness, blood spitting, chest ache, lung wheeze, faint, fear, pale skin, cyanosis. Diagnosis is put with radiography and pulmonary angiography.

What must we do in order to prevent thrombosis- walking in 18 hours after operation, compression stockings, movement of lower limbs in bed (gastrocnemius muscle contraction improves blood circulation in the lower limbs).

When must medical prophylaxis be held?

Obesity, cachexia

Loss of blood over 500 ml

Longtime immobilization (over 2 weeks)

Varicose venous

Cesarean section

Clotting factors increase

How must it be held?

Heparin must be injected subcutaneous 5000 units 3 times a day, for 2 weeks. With the childbirth beginning or 12 hours before caesarian section therapy must be ceased and must be resumed in 12 hours after childbirth. In first days the daily dose must be 15000 later it can be increased to 20000 units, 1 week.

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