If the future mother swells up her ankles and ankles, there is a feeling of numbness, the skin feels like shivers and all this is accompanied by heaviness in the legs, especially in hot weather, mainly in the afternoon, there is reason to be alert. Varicose veins are called their irreversible enlargement and lengthening , occurring as a result of gross pathological changes in venous walls and valve veins. Such symptoms most often occur with the development of venous insufficiency (the blood stagnates in the veins, the outflow is slowed down), which is the precursor of varicose veins. The more dangerous varicose veins during pregnancy and swelling, find out in the article on "Varicose veins in pregnancy, swelling."
Varicose veins of the legs are observed in 20-40% of pregnant women, and more than half of them this disease originated during pregnancy, but not before it. Varicose veins are more common during the 5th-6th month of pregnancy. Each subsequent pregnancy increases the likelihood and severity of varicose veins.
Manifestations of varicose veins
In the initial stages, they do not cause any concern, except for the aesthetic, and after the birth gradually pass. The mesh dilatation of small subcutaneous veins of the legs can survive after delivery, although these veins become less noticeable. At the beginning of the disease, patients are only concerned about a cosmetic defect, then there are complaints of a feeling of heaviness, fatigue, fatigue, raspiraniya in the legs and their swelling after physical exertion (prolonged standing) or by the afternoon, especially during the hot season. In the future, the progression of the disease leads not only to an increase in the number and size of dilated veins, but also to the occurrence of trophic disorders: pigmentation, skin tightening. Heaviness in the legs often accompanies a feeling of discomfort, sometimes the woman is worried by the dull and aching pain that occurs mainly in the feet and legs and does not have a clear localization.
Causes of varicose during pregnancy
One of the main reasons for the development of varicose veins are hereditary disorders of the venous wall elasticity. The risk of developing varicose veins increases with a family predisposition, with the number of pregnancies and the age of the woman. During pregnancy, the venous leg system experiences the maximum load. The leading factors during this period are changes in the hormonal background, an increase in the volume of circulating fluid in the body, compression of the veins by the uterus, weight gain.
External signs of varicose veins at the beginning of the disease are telangiectasias - an expansion of small superficial skin veins with a diameter of up to 1.5 mm, which is noticeable on examination. They appear in pregnant women on the skin of the legs, less often the face, neck, upper body, arms. Teleangiectasias look like enlarged or bursting small vessels: "spiders", "stars", "mesh", "arches" on the hips, under the knees or on the calves. Most women notice telangiectasia on their feet. Sometimes by the evening feet - feet and shins - swell due to increased blood pressure in the veins. Often, swelling can be almost imperceptible, and the only sign of fluid retention is traces on the skin from socks or shoes. You can use your fingertips to press the shin in the place where the bone is probed. If it is swelling, there should be traces of the depressed fingers. Heaviness in the legs often accompanies convulsions (frequent and at night), it is difficult to remove the tension of the muscles of the legs, the feeling of "crawling creepy."
• Changing the hormonal background. The appearance of varicose veins of the legs in early pregnancy is associated with hormonal effects, in particular, with progesterone. The amount of this hormone increases during pregnancy. Progesterone leads to a decrease in the tone of the venous wall and increases its extensibility to 150% of the norm, returning to it only 2 months after childbirth. This is physiologically necessary, as a gradually increasing volume of blood requires an increase in the capacity of the vascular bed, and veins that are more thin-walled than arteries are stretched to a greater extent.
• Increase in the volume of circulating blood. During pregnancy, the amount of blood circulating through the blood vessels increases significantly. It starts with the first trimester of pregnancy, peaking at 36 weeks. These changes lead to a significant increase in the load on the walls of the veins of the lower limbs, it becomes much harder to push blood to the heart. And varicose disease develops.
• Squeezing with the uterus. In the development of varicose veins, the enlarged uterus plays a role only in the third trimester of pregnancy, exerting pressure on the iliac and inferior vena cava, which causes a slowing of the blood flow through the femoral veins to 50%.
• Weight gain. With a normal pregnancy, the expectant mother adds 10-12 kg in weight. With a more significant weight gain (some pregnant women recover by 20-30 kg) varicose veins occur more often. This is due to the fact that, with obesity, venous blood pressure slightly increases due to delayed outflow of blood from the large veins and the right half of the heart. As a result, veins develop with a tendency to develop varicose veins.
Diagnosis of varicose veins
For the diagnosis is often not required any special methods - the diagnosis is based on the analysis of complaints and examination of a pregnant woman. In addition, ultrasound dopplerographic examination of the major veins of the lower extremities is performed. The ultrasound method allows the doctor to see the structure and evaluate the function of the veins of the lower extremities, their valves, and also to detect venous thrombi.
To remove fatigue of the feet it is useful to do self-massage of the feet with any cream that prevents the flow of blood. Do it at home before going to bed. Rubbing the cream, massage the ankles, shins, hips in the direction from the bottom up: this improves the outflow of blood. If you have uncomplicated forms of varicose veins (without vein thrombosis, thrombophlebitis, ulcers on the skin), a light foot massage is also possible and useful. It consists in easy stroking the entire leg with the palm in the direction from the bottom up - from the foot to the groin. The procedure is best performed not only in the evening, but also in the morning, within 5-7 minutes after exercise therapy. This measure will be more effective if parallel courses of massage of the lumbar-sacral region of the spine, as the neuro-reflex effects on this zone have a beneficial effect on the vascular tone of the veins of the legs. Massage is contraindicated in inflammatory changes of veins: phlebitis (inflammation of the vein wall) and thrombophlebitis (inflammation of the vein wall in combination with a thrombus that closes its lumen), with signs of wet eczema (inflammatory skin disease having a neuro-allergic nature). Water procedures are useful: contrast shower for the legs - alternating tight jets of warm and cool water (5-10 minutes per foot). Positive effect on the veins also has walking (walking in comfortable shoes) and swimming. If you begin to notice the heaviness in your legs, you need to see a phlebologist. Only a specialist can prescribe the right treatment and prevention, prevent the development of such a serious ailment as varicose veins.
Compression of veins
Do not use knitwear only occasionally or only in winter, as many patients do, - it must be worn constantly. Elastic compression of the veins is indicated for all patients with chronic venous insufficiency, regardless of its cause. Wearing medical knitwear is the only way to prevent the occurrence and progression of varicose veins and at the same time prevent thrombosis (formation of blood clots in the veins). If the phlebologist recommends, you should wear special compression stockings, tights or knee socks (compression medical knitwear). These products the doctor writes out individually, choosing the degree of compression. They evenly squeeze the leg, not allowing the veins to expand and. thereby increasing the speed of blood circulation and preventing the development of varicose veins. Knitwear is worn in the prone position before getting out of bed and worn during the day, as when lowering their legs, their veins are filled with blood, and no jersey this situation will not change. The key to the success of compression treatment is its regularity.
Medications
The effective means of influencing the tone of the veins are the so-called phlebotonics. They should be prescribed by a doctor based on the results of the examination and examination. Pregnant with the risk of developing varicose veins, for the prevention of venous insufficiency of the lower extremities or alleviation of symptoms in varicose veins, it is recommended to take the drug troxevasin in capsules. It should be applied 2 times (in the morning and in the evening) to apply troxevasingel to the calves, to the popliteal region, after which to lie for 10-15 minutes, lifting your legs. Troxevasin eliminates edema, pain, trophic disorders and various pathological phenomena associated with venous insufficiency. Troxevasin is approved for use in the second and third trimester of pregnancy.
With a feeling of heaviness in the legs, pains, "crawling" in the legs before going to bed, Ginkor Fort can be used in capsules in the morning and in the evening. With systematic (constant) use, the drug reduces the severity of clinical manifestations of chronic venous insufficiency of the lower extremities. It is prescribed for venous insufficiency of the lower extremities: sensation of heaviness in the legs, pains, cramps, trophic disorders (brown skin pigmentation, ulceration). Take the drug in tablets (during the day and evening during meals). The use of the drug is possible from the second trimester of pregnancy.
Surgery
Treatment of varicose veins during pregnancy allows the use of not all methods used outside of pregnancy. Surgical treatment (operation) is indicated only in cases when varicosity is accompanied by chronic venous insufficiency combined with complications of varicose veins. Pregnant women are not allowed to use sclerotherapy (sclerosant is injected into a vein and glues its walls, the current of venous blood ceases). During pregnancy and the first year after childbirth, preference is given to conservative (medicinal) methods of treatment. Delivery of pregnant women with chronic venous insufficiency should be performed in elastic bandages with mandatory continuation of their use in the postpartum period for 4 months.
The drug increases venous tone, reduces vascular permeability for water, has an analgesic effect. It can be used in the second and third trimesters of pregnancy. Another acceptable during pregnancy is Lyoton 1000 Gel. The drug distinguishes safety when used in pregnant women in all trimesters. It is rapidly absorbed, which provides a high concentration of heparin in tissues compared to other local remedies, with creams and ointments. A distinctive feature distinguishing this drug from other similarly used drugs is the pronounced anticoagulant (reducing coagulability of the blood), anti-edematous, anti-inflammatory, analgesic and phlebotonic (boosting venous tone) effect.Detralex is also used. It has a venotonic effect: it reduces the extensibility of the veins, increases their tone and reduces the venous stasis of the blood.
Possible complications
Slowing of blood flow in varicose-dilated veins of the legs, small pelvis, uterus, vagina in combination with damage to the vessel wall creates optimal conditions for thrombosis. To this should be added a violation of the blood coagulation system. The risk of thromboembolic complications in chronic venous insufficiency reaches 10%. Thrombosis of veins (or phlebothrombosis) - the formation of blood clots in the lumen of the vein - blood clots. With complete blockage of the lumen of the vein, there is a sharp pain in the entire limb, with an increase in body temperature and chills, with a decrease in the cutaneous temperature of the affected leg. The limb turns pale and becomes bluish. There is swelling of the entire leg, extending to the abdomen and lumbar region. However, sometimes the only clinical manifestation of thrombosis may be pain when walking. Treatment of phlebothrombosis is usually successful and rarely leads to complications. Vein thrombosis can be complicated by pulmonary embolism. Thrombophlebitis - inflammation of the venous wall with the formation of veins thrombi in the lumen of the vein. Thrombophlebitis tends to migrate and spread up and down the vein, sometimes penetrating from the superficial veins into the deep. With this complication, sharp pains suddenly appear along the course of the thrombosed varicose-dilated vein. It is possible to raise the temperature to 38 ° C. The skin around such a vein becomes reddened and swollen, the vein is felt in the form of a dense, painful crook. Thrombophlebitis is a dangerous disease and, without proper treatment, often leads to complications that threaten a woman's life: pulmonary embolism, sepsis (getting into the blood and tissues of pathogenic microbes and their toxins), deep vein thrombosis, gangrene legs.
Thromboembolism of the pulmonary artery is a very serious complication. Most often, it is caused by thrombi that have arisen in the deep veins of the lower extremities. The most dangerous thrombi, which are attached one end to the wall of the vessel, and the other, free, floats in the lumen of the vein. With a little effort: coughing, sudden movement, straining - the clot breaks and flows into the pulmonary artery with the blood stream. Develops acute heart failure or myocardial infarction. The patient suddenly has shortness of breath, chest pain, hemoptysis may appear. The skin of the nose, lips, ears acquires a cyanotic color or turns pale. Rattles are heard in the lungs. On an echocardiogram, clots are found in the right heart and pulmonary arteries, signs of a violation of the function of the right ventricle of the heart. A sudden development of a serious condition can lead to death if an immediate operation is not carried out. Timely prevention and treatment of chronic venous insufficiency can prevent the development of varicose veins in pregnant women and more serious diseases, such as thrombophlebitis, vein thrombosis and thromboembolism. Now we know what are dangerous varicose veins during pregnancy, swelling.