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What causes venous insufficiency during pregnancy?

What's happening in the body during pregnancy that makes it likely that varicose veins will appear? Will venous insufficiency persist even after pregnancy?

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Doctors Answers (5)

The blood volume increases during pregnancy and the high progesterone levels allow the veins to stretch more than the normal state. Additionally, the pressure exerted on the pelvic veins by the enlarging uterus causes obstruction of the flow of venous blood out of the legs. This results in high pressures in the veins of the legs and labia, and veins tend to stretch when under sustained high pressures. Varicose veins often improve considerably after pregnancy is over and the pressures in the veins decrease, but the enlarged veins remain. Use of elastic support hose which are properly fitted is of considerable help with the leg symptoms during pregnancy, and I think all women who are pregnant should be wearing elastic compression hose. Treatment of significant residual varicose veins before the next pregnancy is important since the varicose veins will worsen with each pregnancy.

The hormones of pregnancy and the weight gain contribute significantly to the problem. The veins will improve but will probably enlarge again with time.

During pregnancy the body accumulates fluid and under the influence of progesterone, vessels dilate. This combination is the perfect storm to cause veins to fail and become insufficient. The majority of patients will have their veins go back to normal after delivery but a substantial minority vein sufferers will have symptoms persists after delivery.

During pregnancy there are increased hormone levels which facilitate the dilation of blood vessels to accommodate the increase in circulating blood volume for the pregnancy. If you have the genetic predisposition for varicosities, they can develop in the first pregnancy and resolve after delivery. However, often after subsequent pregnancies they may not shrink down when hormones return to normal. We recommend all pregnant women wear a medical grade compression to decrease this effect and for comfort. Hose today are much more comfortable and stylish than in the past. If there is insufficiency at this time we typically wait until several months after delivery and/or weaning if breast feeding. At that time we would perform an ultrasound examination to see if there is insufficiency present. During pregnancy we may perform an ultrasound to use as a baseline.

There are several factors that worsen varicose veins and venous insufficiency during pregnancy. Firstly, there is an increase in circulating volume of blood. Hormonal changes may change the distensibility of the vein walls. And, there are mechanical effects of the fetus, compressing veins and impeding venous return. In general, any valve damage that occurs is unlikely to revert to normal after pregnancy. However, leg vein symptoms and appearance may significantly improve after delivery.

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