European Journal of Obstetrics & Gynecology and Reproductive Biology
ReviewInterventions for leg edema and varicosities in pregnancy: What evidence?
Section snippets
Background
Leg oedema, not associated with pre-eclampsia, is found in about 80% of all pregnancies [1]. Varicosity may affect about 40% of pregnant women which may involve the saphenous system and small superficial vessels in the legs. It may also involve the haemorrhoidal and vulvar network. This may be due to several factors: an increase in fluid volume, an alteration in venous smooth muscle tone, and increased pressure within the veins caused by the gravid uterus reducing venous return from the lower
Objectives
To assess, using the best available evidence, any form of intervention used to relieve the symptoms associated with varicosity in pregnancy and to reduce leg edema in pregnancy.
Criteria for considering studies for this review:
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Types of studies
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All randomised trials examining the effects of treatments for varicosity and treatments for leg oedema.
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Types of participants
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Pregnant women suffering from symptoms of varicosity (venous insufficiency) or pregnant women with leg edema.
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Types of interventions
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Methods of the review
Trials under consideration were evaluated for methodological quality and appropriateness for inclusion according to the pre-stated selection criteria. Individual outcome data were included in the analysis if they meet the pre-stated criteria in ‘Types of outcome measures’. Included trial data were processed as described in the Cochrane Reviewers’ Handbook [4].
Trials that meet the eligibility criteria were assessed for quality using the following criteria:
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Generation of random allocation
Results
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Rutosides significantly reduced symptom scores for pain, feelings of heaviness and/or tiredness, nocturnal cramps and paraesthesiae compared with placebo in women with visible varices and such symptoms after 28 weeks’ gestation (relative risk 0.54 CI 0.32, 0.89). Rutosides also led to a reduction in ankle size of a mean of 0.55 cm at a time when ankle size increased slightly in the placebo group (Incomplete data—the mean was not given hence outcome was not included in the final analysis).
Discussion
This review unfortunately can provide very little guidance to pregnant women or their caregivers. The commonest treatments for venous insufficiency in pregnancy are compression hosiery and elevation of the feet. Neither of these methods has been adequately assessed.
Though rutosides appear to help women suffering from venous insufficiency both with symptoms and with ankle swelling, it is not yet clear whether the drug is safe enough to use in pregnancy. O-Beta-hydroxyethyl rutoside is a
Acknowledgements
Cochrane collaboration, pregnancy and Childbirth Group for searching for relevant studies.
Gavin Young conducted the first Cochrane review on this subject.
References (11)
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Special situations: Performance of endoscopy while pregnant
2019, Techniques in Gastrointestinal EndoscopyCitation Excerpt :In between procedures, pregnant women should have foot rest available to prop up their legs while using the computer to avoid lower extremity swelling. Although not reaching significance, there was a trend toward reducing lower extremity swelling in the third trimester in pregnant women [91]. With more women entering the field of gastroenterology, better understanding of the risk for musculoskeletal injuries that they face when performing endoscopy is needed.
The hemodynamic effects of pregnancy on the lower extremity venous system
2018, Journal of Vascular Surgery: Venous and Lymphatic DisordersCitation Excerpt :However, there is a paucity of evidence evaluating the efficacy of compression therapy for the treatment of primary CVI during pregnancy. In one trial by Thaler et al comparing the use of prophylactic compression stockings with no treatment among 42 healthy pregnant women, use of compression stockings did not prevent the emergence of gestational varicose veins but did significantly decrease the incidence of saphenous vein reflux at the saphenofemoral junction and improve leg symptoms.49,50 Similarly, a trial by Jamieson et al51 evaluating the use of thigh-high compression stockings in the immediate postpartum period found a statistically significant reduction in the diameter of the common femoral vein with a concomitant increase in the rate of venous blood velocity after only 30 minutes of compression therapy.
The influence of body mass on foot dimensions during pregnancy
2015, Applied Ergonomics