The hemodynamic effects of pregnancy on the lower extremity venous system

Objective: Pregnancy has significant effects on the lower extremity venous system. Increasing venous pressure and blood volume, in combination with reduced flow rates within the deep veins, predisposes pregnant women to both primary and secondary chronic venous insufficiency (CVI). This review article highlights the specific physiologic and hemodynamic changes that occur during pregnancy and examines the nonpharmacologic, pharmacologic, and invasive interventions that are appropriate for both prophylaxis and treatment of CVI and venous thromboembolism (VTE). Methods: This study is a review article of the key literature related to VTE and CVI in pregnancy. Results: Significant hemodynamic changes occur in the lower extremities during pregnancy. Although well documented and essential to fetal development, these changes can have a negative impact on the maternal lower extremity venous circulation. Consequences of pregnancy can result in venous disease only during pregnancy or, particularly in the multiparous patient, can progress to CVI. An abundance of literature and guidelines exist for the management of VTE during pregnancy; however, the quality and extent of literature based around the management of primary CVI during pregnancy are modest at best. Conclusions: The physiologic changes throughout the arterial and venous systems during pregnancy are well documented. However, there is a paucity of data available to construct guidelines for care, particularly in the pregnant patient with symptomatic superficial venous insufficiency. Further investigation in the form of prospective randomized trials is required to establish appropriate guidelines for treatment.