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CVI and pregnancy

Know the danger signs of CVI and VTE in pregnant patients

Chronic venous insufficiency occurs in up to 80% of pregnant women

A review of the literature on chronic venous insufficiency (CVI) in pregnant women reveals considerable guidance for their treatment. CVI occurs in up to 80% of pregnant women, while around 7 of every 1,000 pregnant mothers face venous thromboembolism (VTE) and pulmonary embolism (PE). Pregnancy causes significant hemodynamic changes within the circulatory system. While these are considered essential for the health of the developing foetus, the changes place considerable stress on the expectant mother’s heart and lower extremity veins.

The researchers from Johns Hopkins Hospital and the Greater Baltimore Medical Center led by Dr Jennifer Heller, analysed 80 studies related to pregnancy, VTE and CVI. The paper, The Hemodynamic Effects Of Pregnancy On The Lower Extremity Venous System’, was published in the Journal of Vascular Surgery: Venous and Lymphatic Disorders.

With regards to the hemodynamic and physiologic changes, the review reveals pregnancy:

·         Decreases systemic vascular resistance

·         Increases heart rate

·         Increases cardiac output

·         Decreases deep venous blood flow

·         Increases deep vein diameters; and

·         Induces a hypercoagulable state

The treatment strategies for primary CVI in pregnancy were reviewed and include indications for non-pharmacologic therapies (compression, reflexology, water emersion), and pharmacologic treatments (non-steroidal anti-inflammatory drugs, fondaparinux, and low-molecular-weight heparin).

With an incidence up to 7 per 1,000 pregnancies, acute VTE remains an important issue in pregnancy. The authors provided a thorough review of VTE prevention during pregnancy, and VTE treatment during pregnancy (including indications for caval filters and management of iliofemoral thrombosis).

“It is important for physicians to comprehend the full extent of the hemodynamic factors that contribute to the increased risk of lower extremity venous disease as well as the most appropriate and effective evidence-based management options,” said Dr Heller.  “While prophylaxis and treatment of VTE has been extensively studied in pregnancy, further research is required to look at the potential effectiveness and long-term safety profiles of new oral anticoagulants in the mother and foetus.”

She also hopes that future randomised trials will evaluate treatment strategies to relieve symptoms associated with chronic venous insufficiency during pregnancy, as complete understanding of these issues helps physicians prepare their patients for these eventualities during pregnancy and treat venous complications effectively.

Pregnancy has significant effects on the lower extremity venous system. Increasing venous diameters and blood volume, in combination with a reduced flow rate within the deep veins, predisposes pregnant women to both primary and secondary CVI,” the authors concluded. “…Further research is required to look at the potential effectiveness and long-term safety profiles of new oral anticoagulants in the mother and fetus. In addition, there is a need for randomized controlled trials to investigate potential treatment strategies to relieve the symptoms associated with varicose veins and venous stasis.”

To download the complete article, open access through April 30, click here