Interventions for varicose veins and leg oedema in pregnancy

 

Abstract

Background

Pregnancy is presumed to be a major contributory factor in the increased incidence of varicose veins in women, which can in turn lead to venous insufficiency and leg oedema. The most common symptom of varicose veins and oedema is the substantial pain experienced, as well as night cramps, numbness, tingling, the legs may feel heavy, achy, and possibly be unsightly. Treatment of varicose veins are usually divided into three main groups: surgery, pharmacological and non-pharmacological treatments. Treatments of leg oedema comprise mostly of symptom reduction rather than cure and use pharmacological and non-pharmacological approaches.

Objectives

To assess any form of intervention used to relieve the symptoms associated with varicose veins and leg oedema in pregnancy.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (September 2009).

Selection criteria

Randomised trials of treatments for varicose veins or leg oedema, or both, in pregnancy.

Data collection and analysis

Both review authors independently assessed trials for eligibility, methodological quality and extracted all data.

Main results

Three trials, involving 159 women, were included.

Varicose veins
One trial, involving 69 women, reported that rutoside significantly reduced the symptoms associated with varicose veins (relative risk (RR) 1.89, 95% confidence interval (CI) 1.11 to 3.22). There were no significant differences in side-effects (RR 0.86, 95% CI 0.13 to 5.79) or incidence of deep vein thrombosis (RR 0.17, 95% CI 0.01 to 3.49).

Oedema
One trial, involving 35 women, reported no significant difference in lower leg volume when compression stockings were compared against rest (weighted mean difference -258.80, 95% CI -566.91 to 49.31). Another trial, involving 55 women, compared reflexology with rest. Reflexology significantly reduced the symptoms associated with oedema (reduction in symptoms: RR 9.09, 95% CI 1.41 to 58.54). There was no evidence of significant difference in the women's satisfaction and acceptability with either intervention (RR 6.00, 95% CI 0.92 to 39.11).

Authors' conclusions

Rutosides appear to help relieve the symptoms of varicose veins in late pregnancy. However, this finding is based on one small study (69 women) and there are not enough data presented in the study to assess its safety in pregnancy. It therefore cannot be routinely recommended. Reflexology appears to help improve symptoms for women with leg oedema, but again this is based on one small study (43 women). External compression stockings do not appear to have any advantages in reducing oedema.

 

Plain language summary

Interventions for varicose veins and leg oedema in pregnancy

Not enough evidence on treatments for varicose veins and leg oedema in pregnancy.

Varicose veins, sometimes called varicosity, occur when a valve in the blood vessel walls weakens and the blood stagnates. This in turn leads to problems with the circulation in the veins and to oedema or swelling. The vein then becomes distended, its walls stretch and sag, allowing the vein to swell into a tiny balloon near the surface of the skin. The veins in the legs are most commonly affected as they are working against gravity, but the vulva (vaginal opening) or rectum, resulting in haemorrhoids (piles), can be affected too. Pregnancy seems to increase the risk of varicose veins and they cause considerable pain, night cramps, numbness, tingling, the legs may feel heavy, achy, and they are rather ugly. Treatments for varicose veins are usually divided into three main groups: surgery, pharmacological treatments and non-pharmacological. The review identified three trials involving 159 women. Although the drug rutoside seemed to be effective in reducing symptoms, the study was too small to be able to say this with real confidence. Similarly, with compression stockings and reflexology, there were insufficient data to be able to assess benefits and harms, but they looked promising. More research is needed.

 

摘要

背景

懷孕下肢靜脈曲張及水腫之處置

懷孕被認為是一個造成女性靜脈曲張發生率增加的主要促成因子。靜脈曲張接著可能造成靜脈功能不全和下肢水腫。靜脈曲張和下肢水腫最常見的症狀是感到大量的疼痛，同時也伴隨有夜間抽筋、麻木、刺痛感、下肢沉重、無力及造成難看的外觀。靜脈曲張的治療通常可分為三種主要方式：手術，藥物和非藥物治療。用藥物及非藥物治療下肢水腫可以使大部分的症狀減輕，但無法治癒

目標

評估減輕懷孕中靜脈曲張及下肢水腫症狀的各種介入治療方式療效

搜尋策略

我們搜尋了 Cochrane Pregnancy and Childbirth Group's Trials Register(Septembe 009)

選擇標準

選擇關於懷孕婦女，治療靜脈曲張或是下肢水腫或是兩者都有的隨機試驗

資料收集與分析

審查作者獨立的評估試驗的資格、方法質量和提取所有資料

主要結論

我們總共選錄了三個試驗，共囊括了159位女性。第一個試驗搜集了69位有靜脈曲張的女性，結果顯示芸香可以有意義的減輕靜脈曲張造成的症狀(relative risk (RR) 1.89, 95% confidence interval (CI) 1.11 to 3.22)。對於使於芸香來治療和對照組比較起來，並無有意義的副作用產生(RR 0.86, 95% CI 0.13 to 5.79)或增加深層靜脈血栓的發生率(R .17, 95% CI 0.01 to 3.49)。第二篇試驗，囊括35位下肢水腫女性，顯示穿著彈性襪對於下肢的體積的改善和其它方式比較起來並無顯著意義(weighted mean difference −258.80, 95% CI −566.91 to 49.31)。第三篇試驗，包含了55位女性，主要是在比較按摩和其它方式的效果。按摩可以明顯減輕下肢水腫所帶來的症狀(reduction in symptoms: RR 9.09, 95% CI 1.41 to 58.54)。在婦女對於各種治療方式的滿意度和接受度上並無顯著差異(RR 6.00, 95% CI 0.92 to 39.11)

作者結論

芸香似乎對減輕懷孕末期靜脈曲張的症狀是有效果的。然而，這個結論是出自於僅有69人的小型試驗，且此文獻中並沒有足夠的資料可以去評估芸香在懷孕婦女使用的安全性。因此芸香並沒有常規性的被建議使用。按摩似乎可以改善女性下肢水腫的症狀，但同樣地這個結論也是出自於僅有43人的小型試驗。外用的彈性襪在研究上顯示對於減輕下肢水腫似乎沒有幫助

翻譯人

本摘要由周產期醫學會(Taiwan Society of Perinatology)林佩萱翻譯

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

沒有足夠關於懷孕靜脈曲張及下肢水腫的治療的証據。靜脈曲張是因為血管壁上的瓣膜變得脆弱，使得血液滯留。這個現象會進而導致靜脈血液循環出現問題，然後造成下肢水腫或腫脹。這條出問題的靜脈會脹大，它的血管壁會被牽扯和出現凹陷，最後使得這條血管在皮表下腫脹成小球的形狀。下肢的靜脈通常在對抗重力作功時最會被影響到，但是會陰部(陰道的開口)及直腸(直腸靜脈曲張會造成痔瘡)也同樣會受到影響。懷孕似乎會增加靜脈曲張的機率，而且會造成相當程度的疼痛、夜間抽筋、麻木、刺痛感、下肢沉重感、無力感，而且外觀相當醜陋。靜脈曲張的治療通常可分為三種主要方式：手術，藥物和非藥物治療。此篇文獻回顧收錄了三篇試驗，共有159位女性。雖然藥物芸香似乎對於減輕症狀是有效的，但礙於小型試驗，結果不可全然採信。同樣地，對於穿著彈性襪和按摩，也沒有足夠的資料可以評估其好處和傷害，但它們看起來是可行的。對於懷孕婦女靜脈曲張和下肢水腫的治療方式及療效，需要更多研究來証實