Why do veins expand during pregnancy?
There are several reasons, and they act simultaneously. Hormones, primarily progesterone, reduce the tone of the venous wall and make it stretchable. Blood volume increases to supply the growing baby, and the load on the veins increases. From the middle of the term, the uterus mechanically compresses the iliac veins, especially when the woman lies on her back. Blood clotting during pregnancy physiologically increases - this is protection against blood loss during childbirth, but at the same time a risk factor for thrombosis. If there is a hereditary weakness of the venous valves, all this manifests itself more clearly.
- Relaxation of the venous wall under the influence of hormones
- Increased circulating blood volume
- Compression of the pelvic veins by the growing uterus
- Increased blood clotting
- Hereditary weakness of the venous valves
- Excess weight and inactivity
How it manifests itself
The first to appear are heaviness and bloating in the legs in the evening, swelling in the ankles, and night cramps in the calves. Later, spider veins and convoluted dilated veins become noticeable, most often on the legs and thighs. A separate option is varicose veins of the vulva and perineum, which causes a feeling of pressure and discomfort when walking; it almost always disappears after childbirth. It is important to distinguish ordinary evening edema from edema with preeclampsia: the latter grows quickly, affects the face and hands, and is combined with increased pressure.
- Heaviness and swelling in the legs at the end of the day
- Swelling of the ankles that goes away overnight
- Cramps in the calf muscles at night
- Visible tortuous veins and spider veins
- Itching of the skin over the dilated vein
- Discomfort and pressure with perineal varicose veins
When is an examination needed?
If there is only evening heaviness and slight swelling, an examination is sufficient. Ultrasound Dopplerography of the veins of the lower extremities is needed in case of severe varicose veins, pain, asymmetric swelling, as well as if there have already been thromboses or there are cases of thrombosis in the family. This test is safe during pregnancy and shows the patency of the veins and the function of the valves. If deep vein thrombosis is suspected, the doctor supplements the examination with coagulation tests, but interprets them adjusted for pregnancy, when the indicators are naturally higher.
- Examination by a phlebologist at the first complaints
- Ultrasound of leg veins with Dopplerography
- Assessment of blood coagulation according to indications
- Exclusion of preeclampsia with rapidly increasing edema
- Observation over time in the second and third trimester
What helps during pregnancy
The basis is a properly selected compression hosiery, which is put on in the morning without getting out of bed, and worn throughout the day. The compression class is selected by the doctor; you do not need to buy high-quality stockings yourself. Regular walking, swimming, resting with your legs elevated, and sleeping on your left side work well. You should avoid prolonged standing, hot baths and saunas, tight high-heeled shoes and constipation. Local gels and ointments during pregnancy are used only as prescribed by a doctor, and tableted venotonics are not always used.
- Compression hosiery of selected grade daily
- Walking and swimming, avoiding prolonged standing
- Rest with legs elevated for 15–20 minutes
- Sleeping on your left side
- Weight control and constipation prevention
- Any medications - only as prescribed by a doctor
Postpartum treatment and prevention
Sclerotherapy, laser obliteration and phlebectomy are not performed during pregnancy: you need to wait at least several months after childbirth, and if you are breastfeeding, discuss the timing with your doctor. During this time, some of the veins contract on their own, and the volume of intervention may turn out to be less than it seemed. Compression stockings are recommended to continue to be worn in the early postpartum period, especially after cesarean section, when the risk of thrombosis is higher. If you are planning a next pregnancy, it is better to approach it with already treated veins.
- Planned interventions - no earlier than a few months after birth
- Repeated ultrasound of veins before deciding on surgery
- Compression in the early postpartum period
- Early activation after caesarean section
- Treatment of varicose veins before planning the next pregnancy
