WHAT PROBLEMS ARE ASSOCIATED WITH VEINS AND PREGNANCY?
The typical scenario of vein problems associated with the pregnant state is the increasing number of painful varicose veins that seem to spontaneously appear and enlarge throughout the 9 months. Typically, the veins are in the calf areas and thighs, although some women develop veins in the vaginal walls and vulva that can be alarmingly large. These vaginal and vulvar vein enlargement can be quite painful and can significantly affect one’s normal routine. Phlebitis has a higher risk of occurring during the pregnancy and presents as a hard, red mass or line under the skin at the site of a previous varicose vein. These episodes are usually self-limited and resolve with time, elevation, non-steroidal anti-inflammatory agents, and sometimes antibiotics, depending on the degree of inflammation. Phlebitis can be repetitive and annoying during this period. If one has phlebitis during pregnancy, it is a good idea to have a venous Doppler ultrasound to make sure there is no evidence for an underlying deep venous thrombosis (DVT).
Deep venous thrombosis tends to present as unilateral swelling accompanied by pain. Sometimes, patients will have significant swelling because the uterus expands with the baby and comprises the main vein draining the legs, the inferior vena cava (IVC). In the event of swelling of the legs, a Doppler ultrasound is a simple test to perform to make sure that there is no evidence for a DVT. If a DVT is present, then blood thinning with injections of Lovenox is indicated for the rest of the pregnancy and 4-6 weeks after pregnancy to try and prevent a pulmonary embolus. Lovenox is not indicated in pregnant women who have prosthetic heart valves. Warfarin (Coumadin) is contraindicated during pregnancy because it does cross the placenta into the babies circulation and can cause birth defects. It can be used after delivery since it does not cross into breast milk. If one has a DVT during pregnancy, one has a high risk for recurrent DVT in subsequent pregnancies, and prophylactic blood-thinning might be indicated.
HOW DO I PREVENT VEIN PROBLEMS DURING PREGNANCY?
It might not be possible to completely prevent varicose veins or other venous complications during pregnancy, but one can reduce the risk for these problems. It is recommended that one exercise regularly but walking for 20 minutes a day. If one carries more weight than is recommended, then the veins have to work harder, and therefore are more prone to developing problems. Elevation of the legs above the waist level if possible will help to return blood towards the heart. Wearing compression stockings throughout the pregnancy helps to keep the veins decompressed, and increases the blood flow back to the heart. There are even maternity compression garments that take into account the expanding uterus. Sleep on your left side with your feet on a pillow. Wedge a pillow behind your back to keep yourself tilted to the left. Since the inferior vena cava is on the right side, lying on your left side relieves the vein of the weight of the uterus, thus decreasing pressure on the veins in your legs and feet. When one sleeps, try sleeping with the left side down with a pillow between the legs, since this position tends to move the uterus of the vena cava.
WHATS THE LONG-TERM OUTLOOK WITH VEINS DURING PREGNANCY?
Even the largest vulvar veins will improve after the baby is born, and one loses weight. The same improvement generally occurs for leg veins, although these changes will not all go away. If further pregnancies are anticipated, it is better to wait until surgical treatment until one has finished bearing children.