Veins in the legs during pregnancy. Varicose veins during pregnancy: causes, characteristics of delivery and the recovery period. Varicose veins after childbirth

28.04.2019

Every woman wants to look good. Therefore, expectant mothers are often upset by appearing on later dates pregnancy, cosmetic defects on the legs in the form of increased vascular pattern, "stars" and small veins on the legs. Friends and acquaintances often diagnose a pregnant woman with varicose veins in this case (and they are usually right). They may also advise on remedies that have worked for them in the past. But do not rush to the pharmacy, dear future mothers! Not all drugs that friends recommend are allowed for a pregnant woman. Today we will try to figure out how to deal with varicose veins, or, as doctors call it, with chronic venous insufficiency, varicose veins.

Varicose veins veins are observed in 20-40% of expectant mothers. Unfortunately, this disease often occurs precisely during pregnancy: out of 15-20% of patients with venous pathology, 2/3 are women, while in 60-80% of cases the disease is associated with pregnancy. Quite often, varicose veins develop not only in women who previously suffered from mild forms of this ailment, but also in healthy, at first glance, expectant mothers. The reason for this is this: the fetus in the uterus, with its weight, squeezes the veins (lower hollow and iliac), passing into abdominal cavity... As a result, an obstacle to the reverse blood flow arises, which entails an increase in venous pressure and, as a result, a violation of the elasticity of the walls of the venous vessels of the legs. The slowing down of blood flow in the varicose veins of the legs creates optimal conditions to form blood clots and can lead to venous thrombosis - blockage of veins. This situation is the reason for the development or exacerbation of varicose veins. This process is most susceptible to women with a burdened heredity, whose mothers also have varicose veins. In addition, an increase in the amount of the hormone progesterone can lead to a weakening of the vascular walls. As a result, venous insufficiency occurs.

Remember that only a doctor should prescribe treatment for the expectant mother, since only he can determine the mechanism of the development of the disease and choose the optimal drug. Pregnant women diagnosed with varicose veins are better observed in specialized centers... Get a referral from your obstetrician-gynecologist to a phlebologist or surgeon if this is not possible.

It is the phlebologist who will tell you which method of conservative treatment during pregnancy will ease your condition. He can prescribe you drugs that can improve blood circulation, reduce the permeability of the vascular wall, and prevent the formation of blood clots. To such drugs of systemic action (for internal use) refers to DOXY-CHEM. This medication should not be used in the first 3 months of pregnancy.

Topical drugs include GEPATROMBIA (gel and ointment), which is available in dosages of 30,000 and 50,000 units. Treatment begins with the use of GEPATROMBIN 50,000. When the condition improves, treatment is continued with GEPATROMBIN 30,000. Ointment or gel is applied in a thin layer on the affected surface 2-3 times a day. GEPATROMBIN can be used at any stage of pregnancy, but only with regular visits to the doctor, since only he can assess the need for its appointment and effectiveness. If necessary, treatment with DOXICHEM and GEPATROMBIN can be combined (the effectiveness of treatment in this case increases).

V complex therapy so-called phlebotonics can be added - tablets with venotonic, veno-strengthening effect (DETRMEX, GINKOR-FORT, VENORUTON, ENDOTELON, ESCU-ZAN, DOXIUM, etc.). The preferred drug for the treatment of varicose veins during pregnancy, DETRALEX is recognized, however, due to the lack of data on the penetration of the drug into milk, its intake is not recommended for nursing mothers. VENORUTON is contraindicated for use in the first trimester of pregnancy, but it can be used during breastfeeding... The use of EN-DOTELON, ESCUZAN, DOXIUM during pregnancy and breastfeeding is contraindicated.

Along with phlebotropic medicines for varicose veins of the legs, drugs from other pharmaceutical groups are used. It can be:

non-steroidal anti-inflammatory drugs (IBUPROFEN, DICLOFEMAC, etc. - in ointments and gels) and, if necessary, antibiotics;
heparin-containing preparations (ESSAVEN-GEL, LYOTON 1000-GEL, etc.);
enzyme preparations (VOBENZIM, FLOGENZIM);
drugs that normalize blood clotting (PENTOXIFILIN, ASPIRIN, DIPIRIDAMOL (KURAITIL), derivatives nicotinic acid and etc.)

The use of these drugs during pregnancy and breastfeeding is extremely limited, they are prescribed according to strict indications by the attending physician, since they all affect the development of the fetus and the formation of organs and tissues, and their uncontrolled intake during pregnancy can lead to deformities and / or underdevelopment of organs. And drugs that affect the rheological properties of blood (its fluidity and coagulability) must also be used under the control of blood clotting in order to avoid bleeding and hemorrhage. It is for these reasons that they must be used with caution, under the supervision of a phlebologist. It should be warned against the thoughtless use of certain types of therapy: only their reasonable combination can be the key to success in the treatment of venous insufficiency. Competent treatment allows you to achieve compensation within a fairly short time (usually 3-4 weeks) venous blood flow and liquidated, clinical manifestations complications.

Various ointments and gels penetrate to a limited depth and, in best case, can affect the intradermal vessels without affecting other organs and systems, which are often one of the reasons for the development of varicose veins. In addition, although in a minimal dose, when penetrated under the skin, they are absorbed into the systemic circulation, and therefore can have an effect on the fetus, which has not been studied in almost all gels and ointments.

Remember: if, when applying gels and ointments, you notice severe redness in the area of the varicose vein, you feel severe pain, the temperature has risen, there is a rapid heart rate or shortness of breath - immediately call " ambulance"! This is the first sign of an inflammatory lesion of the vein - thrombophlebitis.

In general, varicose veins, or chronic venous insufficiency, is not a contraindication to pregnancy - this is just a reason to be more careful about your health. Don't try to hide sore veins underneath long skirt or trousers - it is better to go to the doctor and after a while if correct treatment you yourself will understand that varicose veins can be defeated.

Compression jersey

The best way to prevent the progression of varicose veins and at the same time to prevent thrombosis is bandaging with an elastic bandage and wearing compression (squeezing) knitwear.

You should put on stockings or bandage your legs in the morning without getting out of bed. Wear stockings (or an elastic bandage) all day. These funds must be combined with the use of anti-varicose drugs.

Compression knitwear They look like ordinary women's tights, knee-highs, but very dense in certain places, due to which they prevent the veins from expanding. At correct application each pair of such "overalls" is worn for less than six months. The most important thing is that it does not in the least disrupt the woman's usual way of life. You just need to put on compression tights or stockings - forget about them, because compression hosiery comfortable, it does not interfere with movement, the legs "breathe" freely in it.

The cost of such jersey ranges from $ 30 to $ 100. for a couple. The degree of compression is selected by the doctor. Please note that it is measured in millimeters of mercury, not in denominations.

Regular support tights, which are most often sold in pharmacies, compress the leg evenly and do not provide the correct distribution of the compression, while the medicated jersey provides support in the right areas. If we take the maximum pressure (in the ankle area, where swelling most often occurs) as 100%, then 70% will be on the knee, and the hip will be the area of minimum pressure (40%).

It is very important to start using such underwear as early as possible, preferably before pregnancy, then by the most crucial moment in your life you will have healthy veins. And the pregnancy itself will be easier. Naturally, prevention will need to be continued after childbirth, especially if you already have varicose veins.

How to avoid becoming a victim of varicose veins during pregnancy?

Avoid excessive or sudden weight gain.
Get rid of stockings and knee-highs with tight elastic bands during pregnancy. V preventive purposes it is advisable to wear compression tights.
After a hot bath or shower, rinse your feet with cool water while leaning forward.
Don't squat.
Don't lift heavy objects.
Wear shoes with medium heels (3-4 cm).
Do not sit cross-legged.
Don't smoke: There has been a link between smoking and varicose veins.
Accept ascorbic acid and rutin (vitamins C and P). They have a strengthening effect on the vascular wall and reduce their permeability. Usually these substances are included in multivitamin complexes.
Keep your legs elevated while sleeping and relaxing, and place them on the couch when reading or watching TV.

Varicose veins are one of the common problems with which more than half of women are familiar. Often, the first manifestations or aggravation of the disease occur during the gestation period. This is due to many factors: from changes in hormonal levels and hereditary predisposition to the pressure of the growing uterus on the vessels of the small pelvis. But this problem has a solution. If you know what to do with varicose veins on your legs during pregnancy, you can prevent the disease from progressing and protect yourself and your baby from complications.

Varicose veins are characteristic only for humans, its manifestations affect lower part body. This is due primarily to upright posture and prolonged stay in an upright position. A huge load is created on the veins, which have to resist the force of gravity and "pump" blood through the venous vessels from the feet to the inferior vena cava and further into the heart. When the veins fail, blood stagnation occurs and all the ensuing consequences.

What is varicose veins

Varicose veins are a disease associated with deformation of the veins, most often of the lower extremities, and impaired blood flow in them. The following points play a role in the development of the disease.

Venous wall pathology. Normally, the vein wall includes muscle and connective tissue components. This ensures their elasticity, the ability to resist blood flow. With the flabbiness of the walls, the dilated veins can no longer take their original position. This is how "snakes" appear under the skin.
Violation of the venous valvular system. Normally, throughout the entire course of the veins from the inside, there are special valves that prevent the blood flow from going in the opposite direction. With varicose veins, there are violations in their work. As a result, the blood partially returns back under the influence of gravity.
Change in the work of the muscles of the legs. The muscles of the lower limbs play important role in the prevention of varicose veins. They are like an additional "pumping system", maintain the tone of the veins and prevent the reverse flow of blood.

It is enough for one factor to "give up slack", and the mechanism of varicose veins is triggered, which is not so easy to stop.

What provokes him

Varicose veins are very insidious. Unnoticed by a person, it can progress for years until its manifestations lead to serious complications. Pregnancy is a period when all organ systems are in maximum tension, often at the end of their own capabilities. Therefore, at this time, varicose veins often appear for the first time, or a woman notes a significant progression of the disease.

The main factors when carrying

It is important to understand that if a problem was noticed during gestation, it has existed for more than one year. The following factors can be called provocateurs of varicose veins during pregnancy.

Growing uterus. Already from the 2nd trimester, the uterus occupies most of the space in the small pelvis. This leads to vascular compression and nerve endings... As the term increases, the outflow of venous blood from the lower extremities worsens, it begins to be deposited in the already altered veins and provoke the expansion of others. It is during pregnancy that women often encounter varicose veins in the groin or in intimate places(in the area of the clitoris, large and small labia).
Increased blood volume. The appearance of a second circle of blood circulation (in a child) and the need to provide nutrients developing fetus lead to an increase in the volume of circulating blood. The load on the vessels increases. With a predisposition to varicose veins or initial stage diseases of the veins begin to expand, and the blood in them stagnates.
Gestagens. A prerequisite for normal flow pregnancy is sufficient progesterone levels. It creates conditions for the growth and development of the fetus in the uterus. At the same time, progesterone relaxes smooth muscles - in the intestinal wall, bronchi, uterus, and also in blood vessels. This leads to the fact that the veins lose their elasticity, cannot resist the increased blood flow and varicosely change.
Decreased activity. During gestation, women do not lead such an active lifestyle as before. Especially with an increase in gestation, when a large belly gives an additional load. Muscle work is extremely important for the prevention of varicose veins: their contractions additionally push the blood upward, preventing the return flow.

Other reasons

Also, the following points affect the progression of the disease.

Heredity. In women with a tendency to varicose veins, the disease develops and progresses faster. As a rule, when thorough examination they have a connective tissue defect. Therefore, the walls of the veins, consisting precisely of it, are subject to varicose changes even with the slightest stress. In such women, it can be noted long fingers arms and legs, increased flexibility, tendency to sprains of the ligamentous apparatus. Often they are diagnosed with various types of thrombophilia (disorders in the blood coagulation system), frozen pregnancies at different periods.
Working conditions. At risk for the development of varicose veins are women who, due to their occupation, have to stand on their feet for a long time. These are sellers, hairdressers, doctors.

How does the disease manifest

Many women believe that they know the main symptoms of varicose veins during pregnancy, meaning enlarged and thickened veins. But clinical picture much more varied, it begins to appear long before visible to the eye varicose veins.

Signs of the disease largely depend on the stage. Varicose changes can affect not only the veins of the lower extremities, but the external and internal genital organs. The main cause of genital varicose veins during pregnancy is the growing uterus.

The clinical manifestations of varicose veins on the legs are known to many, but not everyone associates its initial states with impaired venous outflow. There are five stages in the development of the disease.

Tired Legs Syndrome. There is a feeling of heaviness and aching legs in the evening, frequent night cramps, tingling along the normal veins, multiple spider veins. If varicose veins in the groin, the woman feels pulling pains in this area.
The appearance of modified veins. Over time, the woman notes that the veins in the legs, which were previously barely noticeable, have swollen and protrude. Most often, blood vessels appear on inner surface shins, in the popliteal fossa, on the labia. Over time, they turn into "snake balls".
The appearance of swelling of the legs. As the disease progresses, swelling of the lower extremities is difficult to resolve after a night's rest.
Discoloration of the skin of the legs. In the last stages of the disease, when, due to constant stagnation of blood in the lower extremities, tissue nutrition is disturbed, darkening (hyperpigmentation) of the skin occurs. She acquires brown tint... When probing, tuberosities are determined along the entire limb.
The appearance of trophic ulcers. The last stage is characterized by the appearance of ulcers that heal very poorly - for months, even years. A similar manifestation of varicose veins is characteristic after 20-30 years of the development of the disease, and in pregnant women it is extremely rare.

Classification

Phlebologists in practice more often use the definition of varicose veins by stages and CEAP (international classification). Graduation according to ICD-10 (international classification of diseases from 2010 revision) does not reflect the severity of the disease and is used only for coding the disease in the documentation.

The following codes of varicose veins are distinguished according to ICD-10:

I83.9 - varicose veins without complications;
I83.1 - varicose veins with symptoms of inflammation or dermatitis;
I83.0 - varicose veins of the lower extremities with ulcers;
I83.2 - lesion of veins with deep tissue changes (both with an ulcer and with inflammation).

The CEAP classification is a more detailed coding of the disease. It takes into account specific symptoms, causes, the anatomical location of the altered vessels and the pathophysiological aspects of the disease. Next to each letter (CEAP), a number is additionally installed, which indicates the severity of the symptoms.

"WITH" . Indicates the stage of development of the disease. For example, if the index is "0" - there are no visible manifestations, "1" - there are telangiectasias - "asterisks", "2" - single varicose veins.
"E". Encodes the cause of the disease. For example, hereditary predisposition, after surgery or unknown etiology.
"A". Indicates which parts of the veins are affected by varicose veins. For example, only superficial or together with deep ones.
"P". Defines other changes. For example, is there a reverse blood flow, blood clots.

Will the disease go away on its own after childbirth?

Some women believe that the signs of varicose veins during pregnancy will go away on their own after giving birth. However, one should not hope for the complete disappearance of the disease. Many provoking factors will go away (hormones, pregnant uterus), so the symptoms will become less noticeable. The varicose veins of the labia, vagina and groin (if any) will go away, but the disease itself will continue to progress if treatment is not taken in time.

It is important to remember that varicose veins take years. If you do not pay attention to it immediately after childbirth, in 10-15 years a "bouquet" of problems is already guaranteed.

What threatens varicose veins during pregnancy

It is not the varicose veins themselves that are dangerous during pregnancy, but the complications that can develop. Their likelihood increases closer to the 3rd trimester.

Blood clots

Stagnation of blood in altered veins provokes a change in its properties. The risk of blood clots increases, especially in the later stages. They can migrate to other organs, causing major changes. All this can lead to pulmonary embolism (pulmonary embolism), infarction of brain structures.
The likelihood of such complications increases on the eve of childbirth and immediately after them. Therefore, at this time, it is especially necessary to pay attention to the prevention of the disease.

The resulting thrombus in the lower extremities can be accompanied by its inflammation - thrombophlebitis occurs. This often happens during pregnancy. Main manifestations:

the affected leg is swollen;
the vein is painful to touch;
the skin above it is red and hot;
the vein itself is dense to the touch.

If you experience these symptoms, you must urgently seek medical help. This state increases the risks of more serious thrombosis (pulmonary artery, femoral and inferior vena cava) that may have Negative consequences for the fetus and mother.

Bleeding from knots

The skin over varicose veins is often thinner and more easily injured. The walls of the vessels themselves are overstretched. Even the slightest injury can lead to rupture of veins and severe bleeding.

With the localization of altered vessels in the genital area, the likelihood of such a complication increases during childbirth. In addition, bleeding from varicose veins is difficult to stop. The usual compression bandage does not always help; it is often necessary to apply special sutures.

How to confirm the diagnosis

In order to find out whether varicose veins during pregnancy are dangerous for a child and a woman, it is important not only to state the fact of the disease, but to establish all the accompanying violations. Sometimes mild varicose veins can be accompanied by thrombosis central vessels and pose a real threat. All pregnant women with varicose veins need to be tested more often for blood clotting in order to track the likelihood of blood clots in time.

The following methods are used to clarify the stage of the disease.

Functional tests. They were relevant in diagnostics at a time when ultrasound was not yet so widely used. Today, they can be used for a preliminary assessment of the severity of the disease and confirm / refute assumptions. The essence of one of the simple functional tests is as follows. In the supine position with raised legs, a large saphenous vein in the thigh is pinched with a finger. Then, in a standing position, the blood filling of the superficial veins of the lower extremity is studied. Normally, they should be collapsed within 15-20 seconds, after which they are filled with venous blood. If this happens faster, then there is a pathological discharge of blood and a failure of the valve system.
Ultrasound procedure. Ultrasound of veins helps not only to determine the functioning of blood vessels, but also the presence of blood clots in them. For more informational content, various techniques are used, most often it is Dopplerometry (study of blood flow velocity).
X-ray phlebography. The essence of the method is to inject contrast into the veins and take X-rays to study the route of the substance. During gestation, it is not carried out due to the possible harmful influence on the fetus.

Treatment principles

During gestation, the complex of all treatment measures minimum. Surgical interventions are carried out only in extreme cases. The main treatment for varicose veins is carried out after pregnancy. The principles of therapy for ailment during gestation are as follows.

Gymnastics for the legs. Without waiting for the progression of the disease starting from the 1st trimester, you should do it in doses physical activity. Hiking, swimming in the pool, doing yoga - all this will improve blood flow in the legs. Useful to perform special gymnastics, especially for women with a professional threat of varicose veins. The exercises are simple but effective. For example, you need to go up and down. At the same time, the calf muscles work, which prevent blood from stagnating in the deep veins.
Body weight control. Each extra kilogram will increase the volume of circulating blood and the load on the vessels. Therefore, it is important for pregnant women not to exceed the figure of 12-15 kg for the entire period of gestation.
Wearing comfortable shoes. During pregnancy, you should not wear shoes on high heels... Optimally - no more than three to five centimeters.
Use of compression garments. Elastic compression is one of the most important areas of treatment. There is a special underwear (stockings, tights, knee-highs) for pregnant women, where special inserts are developed for the growing belly. Compression garments provide dosed external pressure to the entire limb. Moreover, at the ankle it is maximum, at the hip it is minimum. This stimulates the directed movement of the blood. The choice of compression garments should be taken seriously. It is best to purchase it in consultation with your doctor. Only a specialist can determine whether prophylactic or therapeutic products are needed. It is necessary to stay in such stockings or tights throughout the entire period of gestation and always in childbirth and postpartum period... The doctors' comments confirm the fact that compression underwear is the most effective remedy prevention of varicose veins during gestation.
Preparations for improving the properties of blood. With severe varicose veins and a burdened history (for example, with thrombophlebitis in the past), at the discretion of the doctor, venotonic agents, for example, "Detralex", may be prescribed. Many remedies for varicose veins during pregnancy are prohibited. For example, Trental, Ginkor Forte.
Local preparations for the prevention of complications. To reduce the symptoms of varicose veins during gestation, it is allowed to use gels and ointments. For example, "Lyoton 1000", "Heparin". You can start using them already in the early stages.

When surgery is needed

The operation and subsequent rehabilitation for varicose veins during pregnancy are resorted to in extreme cases. This is due to many factors. But the main thing is that during the gestation period it is impossible to carry out radical treatment, since the pregnancy itself aggravates the condition and somewhat lubricates the clinical picture.

Surgical interventions are performed in cases where the life of the woman and the fetus is at risk. For example, when blood clots form in the lower extremities with high risk separation and further migration. In such situations, it is recommended to install cava filters - special "meshes" in the inferior vena cava, which delay blood clots on the way.

Folk remedies

Everything folk remedies need to be discussed with your doctor. Such home treatment is best done against the background of basic recommendations.

Apple vinegar. It is recommended to wipe the skin over the varicose veins with a vinegar solution.
Infusion of nettle. This herb has a complex effect. For varicose veins, it is recommended to use an infusion. For cooking, you need to take two tablespoons of chopped nettle leaves, pour hot water and darken in a water bath for 30-40 minutes. Store the prepared solution in the refrigerator for no more than a day. Take half a glass twice a day.
Green tomatoes. It is recommended to apply unripe homemade tomatoes to the places of the changed veins at night in courses of 10-14 days.
Spoiled milk. Home sour milk it is necessary to lubricate the lower limbs and wrap it with a bandage overnight. Helps relieve fatigue and puffiness.

Prevention measures

Every woman who has the disease or a tendency to it should know how to avoid the progression of varicose veins during pregnancy. The recommendations are as follows:

move more;
perform self-massage of the legs;
wearing compression stockings or tights;
sleep with a raised leg end;
use ointments with heparin, horse chestnut ("Lioton 1000").

Varicose veins of the lower extremities are common during gestation, especially in women who are prone to the disease. Surgical treatment of varicose veins during pregnancy is carried out only for health reasons. The main measures are the prevention of the progression of varicose veins, expressed in taking medications (tablets, ointments) permitted during pregnancy, wearing compression underwear and maintaining physical activity.

A great time - pregnancy - can provoke a very unpleasant disease - varicose veins(chronic venous insufficiency). According to statistics, 20-30% of women appear after the first pregnancy. In subsequent pregnancies, this percentage grows inexorably and reaches 40-60% in the second pregnancy, as well as up to 80% in the third. As a rule, varicose veins due to pregnancy most often occur in people predisposed to the disease. In many women, the first manifestations of varicose veins are visible even before the onset of the "interesting situation".

Visually, vein problems can look like spider veins and worms. In the first case, we are talking about translucent small vessels, similar to a spider web. They are blue or purple in color, but do not rise above the surface of the skin. "Worms" are, on the contrary, an expansion of the main veins. As a rule, at the same time, their bulging, swelling is observed. These veins, sometimes about the size of a finger, are blue-green in color. But varicose veins are not only cosmetic defect... This is a disease that is extremely dangerous for its complications. Among them, the most common: thrombophlebitis, trophic ulcers, bleeding. The most dangerous is the formation of a blood clot, which can come off and pose an immediate threat to the life of the mother and child.

What is varicose veins? Symptoms of the disease

The mechanism of formation of varicose veins during pregnancy is as follows: blood is "pumped" into the lower extremities along the bed of the arteries, but is retained there, since the veins are partially pinched and cannot provide sufficient blood flow. As a result, venous blood stagnation occurs, which expands the veins from the inside.

The initial stages of varicose veins are practically asymptomatic for a woman - only a slight deformation of the veins is externally detected. In this case, by the end of the day, it is possible that by the morning they completely disappear. As a rule, edema is accompanied by a feeling of heaviness, "fullness" of the legs, fatigue.

In a more neglected state, calf muscles... Basically, they bother the pregnant woman at night. Further, the disease is aggravated by severe pain in the legs and itching of the skin, also worse at night.

The next stage in the development of varicose veins is a significant deformation of the veins. In this case, the veins protrude above the skin, they are dilated, sometimes bizarrely curved. It is worth noting that in some cases (even with severe deformation of the veins) a woman may not have unpleasant or painful sensations... At the same time, changes that are subtle to the eyes can often be combined with serious pain symptoms.

As a rule, the causes of the onset or aggravation of this disease during pregnancy are: hormonal changes the body (which leads to a weakening of the venous wall), an increased volume of blood in the veins (as a result of which the load on the veins increases significantly), the pressure of the growing uterus and fetus, the increasing weight of a pregnant woman. In addition, the individual characteristics the woman's body, in particular the elasticity of the walls of blood vessels, underdevelopment or even complete absence venous valves.

Often during pregnancy, not only varicose veins of the lower extremities are observed, but also varicose veins of the labia, vulva, anus(haemorrhoids). If not treated in time, extensive vulvar varicose veins can rupture the vein, thereby provoking fatal bleeding.

Prevention of varicose veins during pregnancy

Preventive measures must be taken both by those women who have the disease only "on the horizon" and those who do not have obvious manifestations of it. During pregnancy, for this purpose, it is necessary to wear compression stockings (anti-varicose tights are not used during pregnancy) or tightly wrap the legs with elastic bandages. The first option is the most convenient, since it does not require training in the special bandaging technique, which is necessary in the case of bandages. But you should know that it is unacceptable to choose stockings on your own, a phlebologist should do this. He will take into account the degree of compression you need, teach you how to use this product correctly. For example, the doctor will tell you that you need to put on stockings in the morning in a supine position, without getting out of bed. Also, avoid wearing clothing that interferes with blood circulation in the thighs and knees. Choose shoes with 3-5 cm heels.

The next steps to take are to improve blood circulation in the legs with help and repositioning. This means that you need to give your legs a rest and unload them as often as possible. From time to time, you should go to bed, and so that your legs are on a hill (the option of throwing your legs on the table in the American manner is quite suitable). It is also important to perform special simple exercises: circular motions feet, "bike", lifting on toes, rolls "toe-heel". You can lie on your back, raise your legs at a 90-degree angle (or straighten them) and shake.

While sleeping, try to lie on your left side to improve blood flow. Do not cross your legs when sitting or stand for long periods of time. If you have to stand for a long time, periodically go up on your toes. A visit to the pool will be helpful.

Make sure that the weight gain is not very significant, that is, over the norm, since this has a very negative effect on the condition of the veins.

Treatment of varicose veins during pregnancy

Treatment of varicose veins during pregnancy, like other diseases, is unacceptable on its own. This should be done by a specialist.

In most cases, the treatment of this disease in pregnant women should be limited to conservative methods aimed at improving venous outflow. For treatment, all the measures that we described in previous section: wearing special stockings, physiotherapy... This also includes the fresh air, climbing and descending the stairs. The basis of nutrition for a pregnant woman suffering from varicose veins should be vegetables, lean meat, fish, cottage cheese, eggs.

Most often, in the treatment of varicose veins during pregnancy, they use local preparations: gels, ointments. True, it must be borne in mind that not every tool is now suitable, since active substance enters the bloodstream and can be dangerous to the child. The most famous of them: ESSAVEN-GEL, LYOTON 1000-GEL, DIKLOFENAK-GEL, FASTUM-GEL, VENORUTON-GEL, GINKOR-GEL. The doctor will select exactly the one

Today on pharmaceutical market presented many medicines, the action of which is aimed at the treatment of varicose veins. But DETRALEX is recognized as the most preferable during the period of bearing a child. There is another drug - VENORUTON, which is contraindicated for use in the first three months, but allowed after, as well as during breastfeeding. At the same time, treatment with ENDOTELON, ESCUZAN and DOXIUM is unacceptable. Along with phlebotropic drugs, drugs of other pharmaceutical groups are used: IBUPROFEN, DICLOFENAC, VOBENZIM, FLOGENZIM, PENTOXYFILIN, ASPIRIN, DIPIRIDAMOL. True, their use is limited and is possible only in accordance with the strict indications of the attending physician.

In particular difficult cases, with the rapid progression of the disease (or complications such as ascending thrombophlebitis, trophic ulcer), surgical treatment is performed. If there really is a real threat, then doctors decide on surgery, which is usually performed in the first six months of pregnancy. A method of sclerotherapy of veins with special solutions is also possible.

Specially for- Olga Pavlova

Varicose veins are very serious illness resulting from pathological changes in the structure of the walls of blood vessels and their valves. The greatest danger is this disease during pregnancy, since most methods of treatment are contraindicated for the expectant mother. At the same time, it is pregnancy that can provoke the appearance and progressive development of varicose veins.

What is varicose veins?

In order to understand what varicose veins is, you need to know about how the venous system of the lower extremities works. After all, it is on the legs that varicose veins most often occur during pregnancy. It is presented:

superficial veins: large and small saphenous veins, clearly visible with the naked eye;
deep veins located inside the muscles;
communicating veins connecting superficial and deep veins together into a single whole.

The movement of blood through the venous system occurs from the ends of the body to the heart. That is, if we consider the lower extremities, then the blood flow is always directed from the bottom up. In this case, the blood from the superficial veins through the communicating veins enters the deep ones. From there, it travels through the iliac veins and flows into the inferior semi-vein, which transports blood flow to the heart. Sink back under the force gravity it is hindered by bicuspid valves located on the walls of blood vessels.

However, when communicating veins malfunction, or when deep veins cannot cope with their function, an increased blood supply of superficial veins occurs, which in turn leads to vasodilation and venous stasis. If nothing is done in a similar situation, then the walls of the vessels undergo pathological changes and lose their elasticity, tone.

The valves located inside the veins are also subject to irreversible changes. They begin to close loosely. Due to this, a reverse outflow of blood occurs, and the walls of the vessels are stretched even more. As a result, vascular "nets", "cobwebs", "stars", seals and nodes are formed, indicating varicose veins.

The causes of varicose veins

There are many reasons for the occurrence of varicose veins. However, the most common reasons are:

genetic predisposition;
increased blood clotting;
sedentary lifestyle;
fungal and infectious diseases caused by protozoa (trichomoniasis, ureaplasmosis, chlamydia, etc.);
overweight;
hormonal imbalance;
prolonged static position, which leads to venous stasis.

Based on the above reasons, we can say 2-3 such factors are present in almost every expectant mother. After all, it is the change in the hormonal background, as well as the continuously growing load on the veins in the form of the fetus developing in the uterus, that make pregnancy and varicose veins frequent companions each other.

What is the danger of varicose veins?

At first glance, an uninformed person may think that varicose veins during pregnancy are only a cosmetic defect. However, it is not. The greatest danger to a woman's life is the complications of varicose veins: trophic ulcers, which are practically not amenable to treatment, and thrombosis, which can lead to pulmonary embolism, which is often fatal.

In addition, varicose veins during pregnancy can occur not only in the lower extremities, but also in the uterus, vagina and labia. And this form of varicose veins is fraught with serious consequences during labor, up to the rupture of a vein and significant blood loss. That is why it is necessary to recognize the disease and start treating it at the initial stages.

Symptoms of varicose veins

The first symptoms of varicose veins are swelling, heaviness and pain in the legs, fast fatiguability when walking and visual defects: spider veins, clearly visible enlargements, nodes and seals of veins. Even one such manifestation is enough to immediately see a phlebologist, who, using an ultrasound examination, will determine the degree of development of varicose veins and prescribe the only correct treatment.

In the future (in the absence of treatment in the initial stage of varicose veins), symptoms such as:

constant pain in the legs;
night cramps;
swelling that diminishes or disappears after a night's sleep;
changes in skin pigmentation (appear dark spots along the vein);
trophic ulceration, dermatitis or erysipelas.

How to treat varicose veins during pregnancy?

True varicose veins (that is, the one in which the walls of blood vessels and valves have undergone pathological irreversible changes) lends itself only surgical treatment... However, this method cannot be used during pregnancy. Also, you cannot use the modern method of treatment - sclerotherapy, in which a special Chemical substance, contributing to the disappearance of the lumen.

The only thing suitable solution is the use of ointments and gels, as well as homeopathic remedies and drugs to reduce the manifestation of symptoms. Of course, such treatment cannot lead to complete healing, since it is a supportive therapy that prevents the progressive development of the disease and possible complications... In addition to drug treatment the doctor also prescribes mandatory wearing compression stockings and tights. In rare (especially severe cases) women have to wear such stockings even during childbirth.

Some time after giving birth, a woman can go to surgical treatment varicose veins. However, as practice shows, most often pregnant women have false varicose veins. That is, the walls of the veins do not undergo any changes, and the enlarged areas and lumens are formed only due to the increased load associated with bearing a child. In such cases, all symptoms disappear without surgical intervention during the first year after childbirth.

How to prevent varicose veins?

In order for varicose veins during pregnancy not to cause a lot of trouble, due attention should be paid to the prevention of this disease. First of all, you need to control your lifestyle. Prolonged stay in a static position in the presence of a predisposition to varicose veins and pregnancy is simply unacceptable.

It is also important to monitor the volume and quality of food and liquid consumed. If there is a suspicion of varicose veins, it is necessary to completely abandon carbonated drinks and products containing caffeine. In addition, you should watch out for blood pressure... Hypertension in pregnant women can not only provide a lot of trouble in itself, but also provoke the progress of varicose veins.

In addition, women who are prone to varicose veins need to wear special compression underwear: stockings or tights. At the same time, you need to purchase such underwear in pharmacies, taking into account your size and compression class. In total, there are 4 classes of "anti-varicose" linen:

Class I - pressure 18–21 mm Hg.
Class II - pressure 23–32 mm Hg.
III class - pressure 33–48 mm Hg.
IV class - pressure more than 49 mm Hg.

During pregnancy, only the first 2 grades are used. The third is designed for severe forms of varicose veins, and the fourth is designed for congenital anomalies venous system. Remember that it is necessary to put on compression garments only in the supine position, slightly raising your legs!

In addition to compression underwear, pregnant women from the 20th week also need to wear prenatal bandage... They also buy it only in the pharmacy and choose it based on the size. If in doubt about the size of a stocking or bandage, see your doctor. Thanks to a properly selected set, you can not only forget about the possible varicose veins, but also stop feeling the increasing load on the spine. In addition, the prenatal band will support the uterus and thereby reduce fetal pressure on the large vessels in the abdomen.

It is also worth not forgetting about additional preventive measures:

wearing comfortable shoes at low speed;
cold and hot shower for the calf muscles;
yoga or other gymnastics for pregnant women.

Also additional measure Precautions will be a timely visit to the local doctor for the slightest unpleasant or incomprehensible symptoms. In no case should you self-medicate! After all, a pregnant woman is responsible not only for her health, but also for the life of her unborn child!

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During internal changes, inevitable and external manifestations . Hormonal changes affect the elasticity and structure of the veins, which can impede the outflow of blood and cause venous insufficiency. In late pregnancy, fluid retention by the body, enlargement of the uterus, as well as the fetus, leads to compression of the veins in the legs and an increase in venous pressure.

All these factors contribute to the appearance of enlargement of the nodular veins and capillaries., an increase in existing varicose veins.

Today the topic of our article is varicose veins in the legs: symptoms and treatment during pregnancy.

Why are varicose veins on the legs dangerous during pregnancy?

WITH medical point vision, in addition to the swelling and pain caused by varicose veins, there may be even more serious problems.

Immobility of the nodal blood vessels and inevitable growth of the uterus can lead to blood clots, which increases the risk of intravenous blood clots.

Places where blood clots have formed turn red and become hard, it hurts to touch them, even soft touch clothing can cause unbearable pain. In case of blood clots, injections are prescribed to thin the blood. Usually, after such injections and the use of ointments, the blood clots resolve within two weeks.

reference! It is important to know that if you do not pay attention to varicose veins, and ignore the formation of blood clots, the disease can develop into a pulmonary embolism... The most common cause of death for pregnant women in developed countries is the release of a blood clot into the lungs. Such cases occur in one in 500 pregnant women.

How does the disease affect the body of the mother and child?

The mother's heart works faster than usual, as it must provide the fetus with an adequate flow of blood, which accumulates mainly in the legs. it can lead to dizziness and fainting.

Research shows that the volume of vessels the size of a finger can influence the position of an infant in the womb. After childbirth, many of the dilated veins disappear, however poor blood clotting may remain.

Types of varicose veins on the legs

Spider angiomas, telangiectasis... Varicose veins in the form of a spider web or asterisk, veins less than 1 mm in size. Not felt to the touch, it can be blue or red. Can cover the whole leg.

Mesh... Less than 4 mm, sometimes blue, purple, felt to the touch.

Superficial... Easily visible, felt to the touch, sizes over 4 mm.

Varicose enlargement of the great foot vein... Small to medium-sized globules in large veins, usually greenish in color.

Deep varicose veins... This expansion is formed by the deep intravenous system.

At-risk groups

The presence in the family of vascular disease or varicose veins.
Presence of varicose blood vessels before pregnancy.
Repeated pregnancy.
Professions associated with long-term spending time on your feet.
The last months of pregnancy fall into the summer.

Photo

What does varicose veins look like on the legs during pregnancy, photo below:

The causes of the onset of the disease

Hormonal changes in the body of a pregnant woman.
Fetal growth, which affects insufficient blood flow from the pelvis to the heart.
Increased blood volume, as well as fluids in the body of a pregnant woman, which is especially noticeable on the legs.
Curvature of the spine caused by pregnancy.
Multiple pregnancy.
Obesity, weight gain.
Absence preventive measures to prevent varicose veins of the lower extremities.

Symptoms

Pain... Dull pain, especially in the popliteal region. The pain usually makes the legs feel heavy. The pain increases with prolonged time on the legs, decreases with raising the leg up.

Itching... Legs itch. There may be a throbbing burning sensation in places where the veins are dilated, and ankles may also itch.

Swelling of the ankles... Especially in the evening, mild to moderate swelling of the ankles may appear.

Skin changes on the ankles... Eczema, pigmentation, ulcers may appear.

Night cramps... Feeling of tiredness, tension in the legs.

How can you prevent varicose veins?

Treat existing varicose veins before planning a pregnancy.
Avoid spending time on your feet or sitting.
Don't stay on long time without movement.
Avoid sitting on low chairs.
Avoid kicking on sharp corners of tables, pedestals.
Swim regularly, walk in moderate strides in the fresh air.
If necessary, sit for a long time ( long road in the car) you need to constantly change your posture and stretch your legs.
Do not take a hot bath.
Do not be in the sun for a long time.
In hot weather and after physical activity water your feet cold water starting from the feet.
Place legs above heart level during sleep and rest laying pillows.
Use pantyhose against varicose veins as directed by the doctor.
Avoid cross-legged pose, this pose will stop the outflow.
Drink plenty of fluids.
Avoid salt intake.
Avoid wearing tight-fitting clothing.
Avoid wearing high heels.
Do not lift heavy objects.

Diagnostics

Modern medicine can easily establish the degree and type of varicose veins. Ultrasound provides duplex scanning, color display of blood flow.

If necessary, the doctor may prescribe magnetic resonance imaging, venography, or photoplethysmography- a diagnostic method that allows you to get complete information about the outflow of blood.

Treatment of varicose veins in pregnant women is carried out if it has not disappeared within two months after childbirth. Treatment is started three months after childbirth.

Methods for the treatment of varicose veins on the legs in pregnant women

Tights against varicose veins... When thin capillaries or veins appear, a little large sizes, no pantyhose required. Also, with such minor formations, no drugs for internal use, both during pregnancy and during lactation, are provided.

Usually, tights with pressure appropriate for diagnosis are prescribed by a doctor. Tights help reduce venous pressure, pain and tenderness in the legs... Tights are put on in the morning after showering and removed before bed.

Of course, wearing such tights is not very convenient and comfortable, especially in summer, but it is worth it, because they relieve all symptoms. Avoiding the use of pantyhose prescribed by a doctor can be serious and difficult to treat.

Classic operation (stripping / ligation)... Today, this method is rarely used, the only exceptions are those cases when varicose veins are neglected, and cosmetic appearance does not have of great importance... After such an operation, the hospital is left on the same day and returned to normal life after 3-4 days.

Radiofrequency therapy... This method is similar to endovascular laser treatment in that a catheter is inserted into the femoral vein. However, instead of a laser, RF energy is injected into the catheter to help close the dilated vessel.

Ambulatory phlebectomy... It is used when removing nodes using a 3-5 mm incision. It is performed under local anesthesia. The patient is discharged 2-3 hours after the operation.

Sclerotherapy... A method of burning out spider-like varicose veins of medium size. It is carried out by injecting a special drug directly into the vein with the thinnest needle. The treatment takes 15-30 minutes.

Interesting! Laser therapy... One of the most effective and painless ways to treat varicose veins. This treatment does not require anesthesia and is usually done with ice or special cream... As a rule, varicose veins disappear completely in 3 sessions. Laser therapy preferable to take place in winter.

Laser therapy has varieties:

Exo Laser... It is used to remove small arachnids. Leaves no residue.
Endovascular laser... It is used to remove large, perceptible formations. A catheter is inserted into a specific place, where the beam is directed. Bruises remain within 2 weeks after surgery.
Endolaser... A fiber laser is inserted into the damaged vessel, which eliminates the expansion. No scars, but bruising remains for 10 days.

Varicose veins are common but can get worse during pregnancy. This disease easy to treat in modern ways , but for this you need to wait until the end of breastfeeding, so as not to harm the baby.

Pregnant women should not be upset about the appearance of their legs - this is passes if you notice the symptoms in time and consult a doctor... In such cases, it is imperative to go through the duplex ultrasound examination to identify the degree of pathology. To prevent this ugly disease, you must follow all the prescriptions and advice of your doctor.

Useful video

What to do if the veins swell during pregnancy on the legs. What is the best compression garment to use.