Thromboembolism

Abstract

Varicose veins in the legs are common in pregnancy, especially in multigravidae, and on the whole are best treated conservatively, although injection with sclerosant agents (such as sodium tetradecyl sulphate — STD injection) is occasionally performed. Varicosities may appear in the early weeks of pregnancy when blood vessels become more distensible owing to the increase in blood volume and loss of tone of the involuntary muscle in the vessel walls. This is part of the generalized hypotonia of unstriped muscle associated with the altered hormone status of pregnancy. Increased amounts of circulating progesterone are cited as the main causal factor for varicose veins, haemorrhoids, and also for pyelitis (hypotonic ureteric muscle), heartburn (cardiac sphincter), and constipation (bowel wall). Later in pregnancy varicose veins become more pronounced as venous flow is obstructed by pressure from the enlarging uterus. Treatment is to recommend that the patient rest with feet elevated as much as possible, and support with thigh-length elastic net stockings, or elasticated surgical tubular stockinette is often useful. Stockings or stockinette should be put on each morning before rising.