Pregnancy and use of Compression Stockings

The probabilities for the development of varicose veins and venous thrombosis increases significantly in pregnant women.

Pregnancy is one of the few normal conditions that make us more susceptible to venous problems, both due to the development of varicose veins and in conditioning towards an increased risk of venous thrombosis. In both cases, the use of compression stockings is a fundamental tool for prevention and treatment.

Venous problems associated with pregnancy

The most important entities of venous pathology to which pregnant women are at risk are:

  • Varicose veins and
  • Increased thromboembolic risk

In these cases we will see some of the considerations made in medical literature.

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Use of compression stockings during pregnancy

The high prevalence of varicose disease during pregnancy reveals the need to use effective measures since pregnant women show symptoms that suggest it or when prophylaxis of thromboembolic events is required, thus bringing into attention the need to maintain the health of pregnant women and the fetus.

Within these measures, compression stockings are part of the therapeutic arsenal of doctors, being generally considered as a pillar of the treatment of venous insufficiency.

Recommended height for stockings

In the case of pregnant women, the use of stockings that reach the thigh is recommended to be worn both in pregnancy and the puerperium. If full stockings fit poorly or are poorly compliant, move to wearing knee compression graduated stockings.

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Indications for antimenolic stockings in pregnancy or postpartum

The medical literature shows the following indications for compression stockings for the prevention or treatment of thromboembolic disease in pregnant women to be considered by the treating physician who will closely monitor:

  • Pregnant or postpartum patients who are hospitalized and have a contraindication to the use of some parenteral method of thromboprophylaxis, such as heparin (among others).
  • Those women hospitalized after a cesarean section (including receiving any medication for thromboprophylaxis) who are considered to be at a particularly high risk of thromboembolic disease (such as a history of previous venous thrombosis or with more than three risk factors for this);

In preventing thromboembolic disease in bedridden patients, they will be encouraged to wear anti-embolism stockings day and night * that provide graduated compression of 14–15 mmHg until they no longer have significantly reduced mobility.

(*)It is recommended that patients remove anti-embolism stockings daily for hygiene purposes and to inspect the skin condition.

  • Pregnant or postpartum outpatients (not hospitalized) with prior venous thromboembolism (usually combining stockings with an antithrombotic medication);
  • Pregnant or postpartum patients who are traveling long distances for more than 4 hours;
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  • In pregnant or postpartum patients with symptomatic deep vein thrombosis, patients should wear tight stockings during the day. Its use is strictly medically indicated. In many cases, stockings with an ankle pressure gradient of 30-40 mmHg for 2 years are suggested to prevent post-thrombotic syndrome and may continue for longer if there are symptoms of post-thrombotic syndrome.

Intermittent pneumatic compression

Although the use of pneumatic compression devices for the prevention of pregnancy-related thrombosis has not been studied, extrapolating the perioperative data, some authors have recommended its usage for women who require anticoagulant therapy and should temporarily discontinue it, as occurs during labor, delivery or caesarean section.

Patients undergoing caesarean section with at least one additional risk factor may be candidates for thromboprophylaxis with pneumatic compression devices and it has been suggested that it should be used in all those with multiple risk factors. Pneumatic compression devices would be left until the patient becomes ambulatory or until anticoagulation is restarted.

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Bibliographic references

  • Barros Junior N de, Perez MDCJ, Amorim JE de, Miranda Junior F. Pregnancy and lower limb varicose veins: prevalence and risk factors. Jornal Vascular Brasileiro. 2010;9(2):29-35. doi:10.1590/S1677-54492010000200004
  • James Andra H. Venous Thromboembolism in Pregnancy. Arteriosclerosis, Thrombosis, and Vascular Biology. 2009;29(3):326-331. doi:10.1161/ATVBAHA.109.184127
  • Sucker C. Prophylaxis and Therapy of Venous Thrombotic Events (VTE) in Pregnancy and the Postpartum Period. Geburtshilfe Frauenheilkd. 2020;80(1):48-59. doi:10.1055/a-1030-4546
  • Ewins K, Ní Ainle F. VTE risk assessment in pregnancy. Res Pract Thromb Haemost. 2020;4(2):183-192. doi:10.1002/rth2.12290
  • Ismail L, Normahani P, Standfield NJ, 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. 2016;4(4):518-524.e1. doi:10.1016/j.jvsv.2016.06.003