PLANNED SURGICAL TREATMENT OF PRIMARY SYMPTOMATIC CHRONIC VEIN DISEASE IN PREGNANT WOMEN
DOI:
https://doi.org/10.11603/24116-4944.2019.1.10179Keywords:
primary symptomatic chronic vein disease, surgical treatment of primary symptomatic chronic vein disease during pregnancy, safety of surgical intervention during pregnancy, cardiotocographyAbstract
The aim of the study – to evaluate fetal safety, clinical efficacy for pregnant, planned surgical treatment of primary symptomatic chronic vein disease (PSCVD).
Materials and Methods. 457 pregnant women with PSCVD C2S-C4s,Ep,Asp,p.Pr(basis CEAP, 2002) were operated. All pregnant with surgery underwent duplex vein scanning with mapping of pathological areas (refluxes, varicose conglomerates), evaluation of fetal heart rate and uterine tone in pregnant by cardiotocography (CTG), both before and after surgery, according to the World Health Organization’s criteria of 1985. The comparative evaluation of pregnancy course depending on the treatment method of PSCVD was made.
Results and Discussion. The surgical interventions were performed only with the consent of pregnant women in conditions of obstetric hospital by a vascular surgeon "monotechnologist", in the absence of any contraindications for surgical intervention, from the side of the pregnant woman and the fetus without medication premedication, replacing it by "verbal" with local anesthesia using surgical techniques: CHIVA type with descending development of PSCVD in the basin of saphenous veins, with ascending – combination of CHIVA and ASVAL techniques, in the basin of the non-saphenous veins – cirsodesis of the inguinal canals, extending to external genital organs and/or lower extremities by application of seton sutures in the area of the external inguinal ring. In 100 % of pregnant women during surgery, in the postoperative period there were no violations of the somatic status, uterine tone in pregnant women, fetal heartbeat (CTG data) recorded. According to the subjective evaluation by pregnant there were no disorders of the quantity and quality of fetal movements marked, and they also noted in 98 % of cases the positive clinical outcome of surgical intervention.
Conclusions. Indications for planned operative intervention: absence of positive result from conservative therapy of PSCVD of lower extremities, perineum, external genital organs and inguinal canal; the presence of cosmetic deficiencies in the area of the external genital organs and on the open parts of the lower extremities at the request of pregnant women; prevention of obstetric bleeding with varicose veins of the external genital organs and the perineum by preparing the delivery pathway for safe delivery by a natural way; active prophylaxis of thrombophlebitis, thromboembolic complications during pregnancy and in the postpartum period; surgical interventions performed in a planned manner with PSCVD in the basin of saphenous and/or non-saphenous veins are 100 % safe for pregnant women and fetus, with a positive clinical outcome of 98 % of operated in the postoperative period.
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