Tendency for Varicose Vein Formation in Pregnancy

Varicoses remains an important issue related to obstetrics since pregnancy is one of the leading factors causing varicoses in women. Physiological complex and hormonal changes in pregnancy cause veins distension followed by valves dysfunction, endothelial injury marked by the increase of soluble Vascular Cell Adhesion Molecules-1 (VCAM-1) in the circulation, and supported by femoral and great saphenous veins dilatation and reflux in the saphenous-femoral junction. The objectives of this study are to examine the possibility to use measurements of soluble VCAM-1, levels of platelet activations, alterations in veins structure and function of lower limbs veins as early detection methods to reduce the risk of varicoses in primigravida wearing elastic stockings with mechanical compression. A prospective study was performed in a randomized single blinded trial with analysis of variance and repeated measures. The study was done at The Obstetric and Gynaecology Department Immanuel Hospital Bandung, with subjects obtained from the Obstetrics outpatient clinic and Astana Anyar Maternity Hospital Bandung during the period of May 2005 to March 2006. This study consisted of a population of 66 primigravida randomly allocated in to 2 groups, 34 women in control group and 32 women in study group. Women in the study group were instructed to wear elastic stockings, while the control group was not. Measurements of VCAM-1 were performed using ELISA (Enzyme-Linked Immunosorbent Assay). Measurements of veins dilatation were carried out using a Color Duplex Ultrasound. Levels of platelet aggregation were measured with a platelet aggregometer. Examination of 12 weeks and 34 weeks gestational age showed the average of VCAM-1 concentrations in the control group were increased as high as 194,6 ± 113,6 ng/ml compared to 82,5 ± 65,3 ng/ml in the study group. The study group also has less dilatated left femoral veins and great saphenouns veins (subsequently 0,83 ± 0,07 cm and 0,83 ± 0,07 cm) compared to control group (subsequently 1,02 ± 0,35 cm and 1,01 ± 0,35 cm).Tthe incidence of reflux was found only in the study group at sapheno-femoral junction in 6 of 34 women. Alterations in platelets aggregations and count were found not statistically significant in both groups, indicating the process occurred locally and had a minimal effect in the alterations of platelets activation profile. In conclusions, our findings suggest that, the pathogenesis of varicoses started from excessive increase in diameter of lower limbs and pelvic veins, resulting  the endothelial injury and followed by the increase of soluble VCAM-1 expression. Mechanical compression provide protective effect from the development of varicoses shown by the reduced VCAM-1 expression, reduced incidence in developing reflux in blood flow in saphenous-femoral junction, in addition to minimal dilatation of the lower limbs and pelvic veins