Evaluation of the pathophysiology of Varicose veins in pregnancy

Abstract

Abstract Introduction: Varicose veins (VVs) are characterised by tortuous and dilated superficial veins located in the lower extremities. The manifestation of VVs symptoms is contingent upon the severity and progression of the disease. The prevalence of VVs is greater among women, particularly those with a history of pregnancy, in comparison to men as well as women who have not given birth. VVs complications impact patients’ quality of life (QOL) and healthcare costs. Understanding VVs causes may aid patients’ well-being and cut healthcare expenses.

Hypothesis: The development of post-partum VVs is predictable and caused by both mechanical and hormonal factors.

Methodology: This longitudinal study recruited 70 pregnant women (140 limbs) randomly to assess VV development during pregnancy. Participants were monitored across trimesters and postpartum with six assessments. These included demographic data collection, Duplex Ultrasonography (DUS), Vector Flow Imaging (VFI), Photoplethysmography (PPG), Truncated cone limb volume measurement, hormonal blood tests, and Chronic Venous Insufficiency Quality of Life Questionnaire (CIVIQ-20) assessments.

Results: The present study has inked several demographic factors to VVs: older age, multiparity, family history, higher body mass index (BMI), white ethnicity, and jobs involving prolonged standing. Patients with VVs showed larger veins, particularly in the legs, with increased iliac vein compression, progressing to May-Thurner syndrome. DUS highlighted higher reflux time and peak velocity in those with VVs. VFI detected flow changes better than DUS. PPG matched DUS in reflux assessment but not location. Patients with VVs had increased limb volume, higher progesterone and Estroil levels, and lower QoL per CIVIQ-20 scores.

Conclusion: The study affirmed that VVs in pregnancy stem from mechanical and hormonal factors, contributing to existing knowledge. It emphasized VVs' detrimental impact on pregnant women's well- being, stressing the need for early detection, timely treatment, and preventive measures to safeguard pregnant women's QoL.