Women during their pregnancy face two problems, which are quite debilitating and sometimes may pose risk to their lives. If a pregnant lady complains of sudden appearance of a leg swelling during pregnancy, the attending physician or gynecologist must be alarmed and should take appropriate measures to control the situation, otherwise unwittingly a danger to life may lurk large.
Sudden development of a leg swelling
Sudden appearance of leg swelling may herald the beginning of deposition of blood clots inside the deep veins of thigh and legs. This condition is called “Deep Vein Thrombosis” or DVT. Because of lack of exercise and thickening of blood due to hormonal changes during pregnancy, the blood flowing through the deep veins of lower limbs tend to get clotted faster and earlier than its normal timings. When the deep veins of legs become full of clotted blood, the normal mechanism of upward flow of impure deoxygenated blood gets disrupted. This results in accumulation of undesirable impure blood inside the leg and feet resulting in sudden development of swelling of the lower limb.
Blood clotting inside the leg veins must be taken seriously; as there is always likelihood of slipping of clots from the deep leg veins upwards towards the heart and through the heart they may lodge inside the artery of the lung. This is a dangerous situation and in medical terms it is called Pulmonary Embolism (PE). One must know the majority of cases suffering from pulmonary embolism usually meet a fatal end.
Where to go if a pregnant lady develops leg swelling?
Remember any pregnant lady if she suddenly develops swelling in her one or both legs, she must consult a vascular or a cardiovascular surgeon immediately without fail, because this is the only time when your attending vascular surgeon can effectively control the situation and prevent any impending catastrophic outcome of clotted leg veins. Always go to a hospital where availability of modern investigations like Doppler Study, M.R.Venogram, Multi CT Scan, Angiography, Ventilation Lung perfusion Scan and Radionuclide Venography are available. Make sure before entering a hospital whether availability of a full time vascular surgeon in the hospital is there or not.
Appearance of blue-coloured veins over thigh and leg
The second problem a pregnant lady faces is the prominent appearance of spider- like blue-coloured veins on her thighs or legs. They are most prominently visible on a fair complexioned thigh or leg. These blue-coloured veins are actually abnormal veins lying just beneath the skin of leg and thigh. These are called early varicose veins. It looks as if a number of blue-coloured spiders or earthworms are lying under your leg skin.
Why do blue-coloured veins appear during pregnancy?
Because of pressure exerted by a pregnant uterus inside the abdomen on the main collecting veins from the lower limbs lying beneath the uterus, these veins get temporarily and partially or sometimes completely compressed. Due to compression the mechanism of carrying the impure blood from lower limb back to heart gets hampered. This leads to back pressure on the valves situated inside the leg veins.
What are these veins?
Actually, the veins are those blood pipes, which collect impure blood from your lower limbs and carry it back to heart and then on to lung for purification. The job of a vein is difficult, as it has to push blood upwards from the leg against the gravity towards the heart. This particular function of veins is made possible by valves, which open up and allow blood to flow only in one direction but when a person stands up these valves get closed to prevent blood from going back again down the leg. In other words, these valves of veins constantly maintain a unidirectional flow of blood that is always towards the heart. Because of sustained backpressure on the venous valves they become weak and cannot withstand the pressure of impure blood and thus unable to close completely. This incomplete closure of valves allows the blood to go down the legs again. This results in gradual accumulation of a lot of impure blood into the deep as well as superficial system of veins.
What to do if a pregnant lady has prominent blue coloured veins?
Because of these changes in the dynamics in venous function two problems arise. First is the appearance of blue coloured spider-like venous on the surface of thigh and legs, secondly appearance of swelling in the feet and legs on standing or sitting with legs hanging for more than one hour. Swelling in the feet and legs are more prominent during daytime and or at the end of the day. Swelling disappears in the morning after getting up from the bed.
If a pregnant lady suffers from recurrent swellings in the feet and leg or develops blue coloured network of veins she must consult a vascular or cardiovascular surgeon and seek his advice for maximum relief. In such situations the use of graduated compression stockings and regular walk and other morning exercises are helpful. Sometimes blood thinners are given to maximize the flow. Regular consultation with a vascular surgeon is essential even after delivery to prevent any further complication of these abnormal veins.
The author is a senior Vascular & Cardio Thoracic Surgeon, at Indraprastha Apollo Hospitals, New Delhi