Indications to planned surgical treatment of pregnant women with primary symptomatic chronic disease of the veins of the lower extremities, the external genitalia, the perineum or in their combination in a short-term stay in a hospital

Abstract

The aim of thwe work: to develop and implement strictly individualized indications for safe, both for mother and child, effective, pathogenic planned surgical treatment of pregnant women with primary symptomatic chronic vein disease (PSCVD) in a short-term stay in an obstetric hospital (up to 72 hours by IAAS terminology).

Materials and Methods. On the basis of the Public Facility "Regional Perinatal Center" of the Rivne Regional Council for the period from the beginning of 2013 to the first quarter of 2018, 256 pregnant women with PSCVD C2s-C4s,Ep,Аs,p.Pr (basis CEAP, 2002) were operated. Indications to planned surgical intervention are the following: 196 pregnant women (76.56 %) – growth of chronic venous insufficiency of the lower extremities, the external genitalia, the perineum despite conservative therapy; in 34 patients (13.28 %) with the aim of preparing the maternal passages for natural delivery with varicose veins of the external genitalia and the perineum, to reduce the risk of bleeding in case of possible rupture of varicose nodes and by narrowing the indications to surgical delivery; in 26 patients (10.16 %), according to their wishes, the reduction of cosmetic problems caused by varicose veins of the external genitalia and / or on the open parts of the lower extremities. All operated pregnant women were performed duplex scans of veins with cartography of pathological zones (refluxes, varicose conglomerates), cardiotocography (CTG), fetometry (FM), both before and after surgery.

Results and Discussion. The surgical interventions were performed only with the consent of the pregnant women, in the absence of any contraindications to surgical intervention, both from the somatic and obstetric statuses in the conditions of the obstetrical in-patient department. All surgical interventions were carried out without premedication, tumescence anesthesia and surgical technique by CHIVA type were used with the downward development of PSCVD, and with the ascending - combination of CHIVA and ASVAL techniques. In 100% of pregnant women during surgery, in the postoperative period violations of the somatic status, uterine tone in pregnant women, the heartbeat of the fetus (data of CTG, FM) have not been recorded. According to the subjective evaluation by pregnant women, violations of the quantity and quality of fetal movements have not been noted and they noted in 98 % of cases the positive clinical outcome of surgical intervention. Operated in the II-nd  and at the beginning of the III-rd trimesters, 85 % were within 24 hours, 10 % for 48 hours in the hospital, after that they were discharged under supervision of obstetrician-gynecologist by place of residence, 5 % of operated persons at the end of the III-rd trimester stayed in the hospital until childbirth.