Paper Example: The Treatment of Varicose Veins in Pregnant Women

Introduction

Scientific evidence indicates that multiple hormonal and physiological changes accompany the pregnancy process. These changes, combined with hemostats, can trigger health problems or discomfort during pregnancy. Within this context, an example of the problem is the prevalence and incidence of varicose veins in pregnancy which can lead to other complications. Around 70-80% of pregnant women have a high probability of developing varicosities that can start from the first trimester of pregnancy, accompanied by uncomfortable symptoms, risk factors, and altered quality of life (Burch & Briarava, 2018). Minimal venous dilation leads to focus on a conservative action. However, if more dilated veins are present, a more interventional treatment should be performed. Besides, sufficiently compressive stockings (greater than 32 mmHg) improve the venous return of the legs during pregnancy and, therefore, can prevent thrombosis in high-risk patients and improve symptoms.

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Definition of A Practice Issue to Be Explored Via A PICO(T) Approach

Problem

Varicose veins condition is common as a common health problem that appears during women's pregnancy period.

Intervention

The treatment of varicose veins in expectant females can be done through either invasive medical or conservative intervention.

Comparison

The problem corresponds to the emergence of a concern that leads to questioning the reason for users' care in their reality. This concern arises when observing ignorance and consulting with professionals about the unscientific approach in the care, treatment, and prevention of varicose veins in pregnant women.

Outcome

Among the symptoms reported by pregnant women are: pain, a feeling of weight in the lower limbs, itching, swelling, cramps, tingling, changes in skin color, and edema, among others. The risk factors reported in the formation of varicose veins are pregnancy, number of pregnancies, age, obesity, a long time in the same position, and female sex. Starting from this context, clients must be educated about lifestyle changes and the different treatment options that they can count on, whether it be pharmacological, non-pharmacological, or surgical treatment.

Treatment

The above is why professionals in Gynaecology-Obstetrics must know and understand from a scientific basis the different treatment options for people who present this pathology. That is why the study's objective was to analyze the finest accessible scientific evidence linked the most invasive to conservative compared to medical intervention.

Based on the above analysis, the question posed is: Is pregnant women, conservative medical intervention compared with invasive intervention, including surgery, more effective for the treatment and prevention of the subsequent appearance of varicose veins in the lower limbs? The clinical question requires a systematic approach to be answered, so it uses the acronym PICO (population, intervention, comparison, and results).

Sources of Evidence That Could Be Potentially Effective in Answering A PICO(T) Question

Since the type of research question has been established, the most suitable source of evidence that could be potentially effective in answering the PICO(T) question is systematic Reviews, randomized controlled clinical trials (RCTs), meta-analysis, and clinical Practice guidelines. Different types of instruments will be used to validate the information. FLC 2.0 (critical reading card) will be used, a tool that allows analyzing the quality of scientific evidence and generating evidence tables. Regarding the Clinical Practice Guidelines (CPG), the AGREE II instrument, the latest version will be used. Finally, the explanation of the levels of evidence and grades of recommendations is highly recommended to analyze therapy or intervention studies critically.

Explanation of The Findings from Articles or Other Sources of Evidence

From the results recorded in the article, chronic venous insufficiency results from biochemical and structural abnormalities of the vein wall. Therefore, the management of varicose veins in pregnant women pathology is divided into three main groups: pharmacological, non-pharmacological, and surgical treatments. When this type of pathology occurs, edema is a condition that may be present, establishing the main objective of reducing symptoms and using pharmacological and non-pharmacological approaches. In addition, the methods to treat varicose veins or edema in the lower limbs in pregnant women include pharmacological interventions such as phlebotomids or sclerotherapy, non-pharmacological interventions such as the use of compression stockings, elevation of the legs, rest, exercise, immersion in water, and reflexology; Finally, as a third option, he indicates surgical interventions. Additionally, phlebotomids are pharmacological treatments that work by swelling venous tone and averting edema. Although these drugs have vagotonic mechanisms of action, most studies show low-quality evidence of benefit. In a Cochrane literature review, only 28% of the included studies on this topic included standard diagnostic criteria.

Moreover, phlebotomists as vasoactive drugs that are related to increased venous tone and prevention of edema. Such drugs include outsides, hydrosmin, diosmin, calcium dobesilate, chromocarbon, gotu kola, disodium phloberdate, French nautical pine bark extract, grape seed extract, aminaftone, and 0- (b-hydroxythylrutoside), which is a semisynthetic compound. Although rutosides can help manage varicose veins, it is still unknown if the drug is safe during pregnancy. Within this context, "Intervention for IPV-exposed pregnant women" (2019) conducted an RCT that compared the efficacy of the oral phlebotonic O - (b-hydroxyethyl) rutoside, with palliative for the treatment of varicose veins throughout gestation. This study showed that rutoside meaningfully abridged the symptoms related to varicose veins with a RR of 1.89 and a 95% CI 1.11 to 3 (Burch & Briarava, 2018). In this study, there were no statistically noteworthy differences in the rate of side effects between the treatment groups.

Regarding these drugs, "Lifestyle Intervention in pregnant women with PCOS," (2020) also reports that rutosides are very effective intervention that can decrease the indications of varicose veins throughout gravidity. This is reaffirmed by "Lifestyle Intervention in pregnant women with PCOS," (2020) in 2017 in their research entitled "Updating the treatment of venous insufficiency in Pregnancy" when they state that there is a moderate-quality indication that suggests that rutosides seem to aid alleviate the signs of varicose veins. At the end of pregnancy these drugs have a beneficial effect in treating chronic venous insufficiency in the third trimester of pregnancy, therefore, the basic management of all degrees of varicose during pregnancy should be by conservative means, such as adequate elastic support that has sufficient strength to keep varicose veins fully compressed. Likewise, compression therapy is advantageous since it is cheap and easy to place, but its main limitation is user non-compliance, limiting its effectiveness.

The Relevance of The Findings from Chosen Sources of Evidence to Making A Decision Related to A PICO(T) Question

The relevance of these findings suggests that there is a necessity for randomized controlled trials to examine possible treatment approaches to alleviate the signs of varicose veins and venous stasis. The author notes that there are strategies for managing minor extremity venous illness related to gestation. However, unfortunately, scientific research's quality and scope based on the management of varicose veins at an early stage during pregnancy are modest. Besides, the clinical benefits of treating varicose veins with compression stockings during pregnancy may outweigh the possible harm to the mother or the fetus. They consider that interventional therapies are contraindicated in pregnancy, for which reason they point out compression therapy as the only viable option that has even shown an improvement in the quality of life of the users; however, they agree, like many authors on the need for larger studies.

Conclusion

Compression stockings are considered the most indicated treatment for the relief and reduction of symptoms associated with varicose veins in pregnancy; however, it does not prevent subsequent occurrence. Compressive therapy has not been adequately evaluated under a rigorous and reliable randomized controlled trial that allows a clear guideline to be established. Similarly, outsides and oral anticoagulants appear to help women with varicose veins in pregnancy. However, according to scientific evidence, it is not clear that these drugs are safe enough in pregnancy for both the mother and the fetus. Invasive treatment, including surgery, is not recommended during pregnancy because the risks outweigh the benefits. It is suggested that this type of intervention should not be performed during pregnancy only in delicate cases that warrant it. The literature suggests that the appropriate time for invasive treatment, including surgery, is when the user considers that she does not want to have more children or a few months after the baby is born. Reflexology, foot massage, and water immersion seem to help reduce lower limb edema in pregnant women.

References

Burch, J., & Briarava, M. (2018). What are the effects of conservative treatment for pregnant women with cervical intraepithelial lesions and early invasive cancer? Cochrane Clinical Answers. https://doi.org/10.1002/cca.2016

Intervention for IPV-exposed pregnant women. (2019). Case Medical Research. https://doi.org/10.31525/ct1-nct04068662

Lifestyle intervention in pregnant women with PCOS. (2020). Case Medical Research. https://doi.org/10.31525/ct1-nct04216485Lifestyle intervention in pregnant women with PCOS. (2020). Case Medical Research. https://doi.org/10.31525/ct1-nct04216485