Analysis of venous insufficiency risk factors and appearance of clinical symptoms during pregnancy and puerperium in a group of pregnant women with and without symptoms of venous insufficiency of the lower limbs

Abstract

Objective: To analyze risk factors for venous insufficiency and the appearance of clinical symptoms during pregnancy and childbirth in the group of pregnant women without (nvi) and with symptoms of venous insufficiency (vi) of the lower limbs that was present during the first visit in the first trimester of pregnancy. Material and methods: The study included 103 pregnant women consulted at the Clinic of Vascular Disease „Calisia” in Kalisz in the years 2006–2008. Venous system was assessed in CEAP clinical classification. Patients were divided into two groups depending on the presence or absence of symptoms of venous insufficiency of the lower limbs during the first examination, which took place in the first trimester of pregnancy. Pregnant women with symptoms of vi qualified for the test group (B), whereas patients without signs of vi constituted the control group (K). The observed changes in each group in the second, third trimester and postpartum were compered to the first trimester. Results: In the control group, clinical symptoms such as telangiectasis, varicose changes, and edema increased with advancing gestational age, with the greatest intensity in the third trimester. Similar intensification of symptoms was observed in the group B. The incidence of some of the observed clinical symptoms decreased at 6 weeks postpartum, whereas some of them remained unchanged. In the group K statistically significant differences were found between the incidence of symptoms in the II and III trimesters compared to the first trimester. There were no statistically significant differences between puerperium and the first trimester. No statistical significance was found in the group B. In the puerperium a gradual reduction of clinical symptoms was observed. In the group K the greatest changes were observed in the prevalence of edema and pain. Similar changes were observed in women with venous insufficiency. Conclusion: Pregnancy predisposes to chronic venous insufficiency. Edema of the lower limbs is not an authoritative exponent of the severity of venous insufficiency during pregnancy, due to the emergence of different pathogenesis of these changes during pregnancy. The six-week postpartum period is not sufficient to normalize the functional state of the venous system in terms of changes occurring during pregnancy.