Prospective cohort study of the venous system through duplex mapping in the puerperal pregnancy cycle
Estudo de coorte prospectivo do sistema venoso através do mapeamento duplex no ciclo gravídico puerperal
Palavras-chave:
Gravidez, Insuficiência Venosa, Ultrassonografia Doppler, Decúbito DorsalResumo
Objective: To evaluate the changes in the venous system during pregnancy and childbirth in pregnant and postpartum women without previous venous disease. Methods: This is an observational, analytical prospective cohort study carried out from May 2021 to October 2021, in pregnant women undergoing caesarean section on their first postoperative day, with duplex mapping being performed to assess the diameter and reflux of the great and small saphenous veins, mean venous flow velocity in the common femoral veins in dorsal decubitus and the comparison of velocities when adopting the left and right lateral decubitus position before caesarean section and on the first postpartum day. Result: 49 pregnant women were evaluated, and an increase in flow velocity was observed when adopting the right and left lateral positions in relation to pre- and post-cesarean section in dorsal decubitus. The mean velocity of venous flow from the common femoral vein increased in the postpartum period, regardless of the decubitus adopted. Conclusion: There was an improvement in flow in the femoral vein with the change from dorsal decubitus to right and left lateral decubitus and after termination of pregnancy.
Downloads
Referências
Baumann, H., Kirkinen, P., Mueller, R., Schnarwyler, B., Hugh, A., & Hugh, R. Blood flow velocity waveforms in large maternal and uterine vessels throughout pregnancy and postpartum: a longitudinal study using Duplex sonography. BJOG: An International Journal of Obstetrics and Gynaecology, v. 95, p.1282–1291, 1988. Disponível: https://doi.org/10.1111/j.1471-0528.1988.tb06819.x.
Boivin, P., Cornu-Thenard, A., & Charpak, Y. Pregnancy induced changes in lower extremity superficial veins: An ultrasound scan study. Journal of Vascular Surgery, 32(3), 570–574, 2000. Disponível: https://doi.org/10.1067/mva.2000.107991.
Brito, C. J. de, Silva, R. M. da, & Araújo, E. L. de. Cirurgia Vascular. 4th ed. Thieme Revinter, p. 5543-5578,2020.
Castro e Silva M, Cabral ALS, Barros Jr N, Castro AA, & Santos MERC. Diagnóstico e tratamento da doença venosa crônica - Normas de orientação clínica da sociedade brasileira de angiologia e cirurgia vascular. Jornal Vascular Brasileiro, v. 4, p. 185–195, 2005.
Departamento de Informática do SUS – DATASUS, 2021. Disponível: https://datasus.saude.gov.br.
Eklof, B., Perrin, M., Delis, K. T., Rutherford, R. B., & Gloviczki, P. Updated terminology of chronic venous disorders: The vein-term transatlantic interdisciplinary consensus document. Journal of Vascular Surgery, v. 49, p. 498–501, 2009. Disponível: https://doi.org/10.1016/j.jvs.2008.09.014.
Evangelista, M., Slompo, K., & Timi, J. Venous thromboembolism and route of delivery – review of the literature. Revista Brasileira de Ginecologia e Obstetrícia, v. 40, p. 156–162, 2018. Disponível: https://doi.org/10.1055/s-0037-1621742.
Gardenghi, L. A., Dezotti, N. R., Dalio, M. B., Joviliano, E. E., & Piccinato, C. E. Gestational lower limb edema and venous reflux in healthy primigravidae. International Angiology, v. 36, p. 569–573, 2017.
Gloviczki, P., Comerota, A. J., Dalsing, M. C., Eklof, B. G., Gillespie, D. L., Gloviczki, M. L., Lohr, J. M., McLafferty, R. B., Meissner, M. H., Murad, M. H., Padberg, F. T., Pappas, P. J., Passman, M. A., Raffetto, J. D., Vasquez, M. A., & Wakefield, T. W.The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. Journal of Vascular Surgery, v. 53, p. 2–48, 2011. Disponível: https://doi.org/10.1016/j.jvs.2011.01.079.
Goulart, V. B., Cabral, A. C. V., Reis, Z. S., Navarro, T. P., Alves, S. L., De Miranda, P. R. T., Sarquis, A. L., & De Lima Rezende, C. A. Anatomical and physiological changes in the venous system of lower limbs in pregnant women and findings associated with the symptomatology. Archives of Gynecology and Obstetrics, v. 288, p. 73–78, 2013. Disponível: https://doi.org/10.1007/s00404-013-2728-9.
Heit, J. A., Kobbervig, C. E., James, A. H., Petterson, T. M., Bailey, K. R., & Melton, L. J. Trends in the Incidence of Venous Thromboembolism during Pregnancy or Postpartum: A 30-Year Population-Based Study. Annals of Internal Medicine, v. 143, p. 697, 2005. Disponível: https://doi.org/10.7326/0003-4819-143-10-200511150-00006.
Ismail, L., Normahani, P., Standfield, N. J., & Jaffer, U. A systematic review and meta-analysis of the risk for development of varicose veins in women with a history of pregnancy. Journal of Vascular Surgery: Venous and Lymphatic Disorders, v.4, p. 518-524, 2016. Disponível: https://doi.org/10.1016/j.jvsv.2016.06.003.
Ismail, S. K., Norris, L., Muttukrishna, S., & Higgins, J. R. Thrombin generation post elective caesarean section: Effect of low molecular weight heparin. Thrombosis Research, v. 130, p. 799–803, 2012. Disponível: https://doi.org/10.1016/j.thromres.2012.01.008.
Kerr, M. G., Scott, D. B., & Samuei, E. Studies of the Inferior Vena Cava in Late Pregnancy. British Medical Journal, v. 1, p.522-524, 1964.
Lohr, J. M., & Bush, R. L. Venous disease in women: Epidemiology, manifestations, and treatment. Journal of Vascular Surgery, v. 57, p. 37-45, 2013. Disponível: https://doi.org/10.1016/j.jvs.2012.10.121.
Macklon, N. S., & Greer, I. A. The deep venous system in the puerperium: An ultrasound study. International Journal of Obstetrics and Gynaecology, v. 104, p. 198–200, 1997. Disponível: https://doi.org/10.1111/j.1471-0528.1997.tb11044.x.
Macklon, N. S., Greer, I. A., & Bowman, A. W. An ultrasound study of gestational and postural changes in the deep venous system of the leg in pregnancy. International Journal of Obstetrics and Gynaecology, v. 104, p.191–197, 1997. Disponível: https://doi.org/10.1111/j.1471-0528.1997.tb11043.x.
Meissner, M. H., Gloviczki, P., Bergan, J., Kistner, R. L., Morrison, N., Pannier, F., Pappas, P. J., Rabe, E., Raju, S., & Villavicencio, J. L. Primary chronic venous disorders. Journal of Vascular Surgery, v. 46, p. 54–67, 2007. Disponível: https://doi.org/10.1016/j.jvs.2007.08.038.
Miranda, F., Geral, J., Kikuchi, R., Campos, W., Marcelo, J., & Liberato De Moura, R. Projeto Diretrizes SBACV- Insuficiência venosa crônica. Sociedade Brasileira de Angiologia e Cirurgia Vascular, p. 1–34, 2015.
Rabhi, Y., Charras-Arthapignet, C., Gris, J.-C., Ayoub, J., Brun, J.-F., Lopez, F.-M., Janbon, C., Mars, P., & Dauzat, M. Lower limb vein enlargement and spontaneous blood flow echogenicity are normal sonographic findings during pregnancy. Journal of Clinical Ultrasound, v. 28, p. 407–413, 2000. Disponível: https://doi.org/10.1002/1097-0096(200010)28:8<407::AID-JCU5>3.0.CO;2-S.
Ropacka-Lesiak, M., Jarosław, K., & Breborowicz, G. Pregnancy-dependent blood flow velocity changes in lower extremities veins in venous insufficiency. Ginekologia Polska, v. 86, p. 659–665, 2015. Disponível: https://doi.org/10.17772/gp/59224.
Sénat, M.-V., Sentilhes, L., Battut, A., Benhamou, D., Bydlowski, S., Chantry, A., Deffieux, X., Diers, F., Doret, M., Ducroux-Schouwey, C., Fuchs, F., Gascoin, G., Lebot, C., Marcellin, L., Plu-Bureau, G., Raccah-Tebeka, B., Simon, E., Bréart, G., & Marpeau, L. (2016). Postpartum practice: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF). European Journal of Obstetrics & Gynecology and Reproductive Biology, v. 202, p. 1-8, 2016. Disponível: https://doi.org/10.1016/j.ejogrb.2016.04.032.
Skudder, P. A., & Farrington, D. T. Venous conditions associated with pregnancy. Seminars in dermatology, v. 12, 72–77, 1993.
Sparey, C., Sissons, G., Haddad, N., Rosser, S., & de Cossart, L. Serial colour flow duplex scanning of the veins of the lower limb throughout pregnancy. International Journal of Obstetrics and Gynaecology, v.106, p. 557–562, 1999. Disponível: https://doi.org/10.1111/j.1471-0528.1999.tb08324.x.
Wittens, C., Davies, A. H., Bækgaard, N., Broholm, R., Cavezzi, A., Chastanet, S., de Wolf, M., Eggen, C., Giannoukas, A., Gohel, M., Kakkos, S., Lawson, J., Noppeney, T., Onida, S., Pittaluga, P., Thomis, S., Toonder, I., Vuylsteke, M., ESVS Guidelines Committee, Rosales, A. (2015). Editor’s Choice – Management of Chronic Venous Disease. European Journal of Vascular and Endovascular Surgery, v. 49, p. 678–737, 2015. Disponível: https://doi.org/10.1016/j.ejvs.2015.02.007.
