Interventions for varicose veins and leg oedema in pregnancy

Background; Pregnancy is presumed to be a major contributory factor in the increased incidence of varicose veins in women, which can in turn lead to venous insufficiency and leg oedema. The most common symptom of varicose veins and oedema is the substantial pain experienced, as well as night cramps, numbness, tingling, the legs may feel heavy, achy, and possibly be unsightly. Treatment of varicose veins are usually divided into three main groups: surgery, pharmacological and non-pharmacological treatments. Treatments of leg oedema comprise mostly of symptom reduction rather than cure and use pharmacological and non-pharmacological approaches. Objectives: To assess any form of intervention used to relieve the symptoms associated with varicose veins and leg oedema in pregnancy. Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (October 2006). Selection criteria: Randomised trials of treatments for varicose veins or leg oedema, or both, in pregnancy. Data collection and analysis: Both review authors independently assessed trials for eligibility, methodological quality and extracted all data. Main results: Three trials, involving 159 women, were included. Varicose veins: One trial, involving 69 women, reported that rutoside significantly reduced the symptoms associated with varicose veins ( relative risk (RR) 1.89, 95% confidence interval (CI) 1.11 to 3.22). There were no significant differences in side-effects (RR 0.86, 95% CI 0.13 to 5.79) or incidence of deep vein thrombosis (RR 0.17, 95% CI 0.01 to 3.49). Oedema: One trial, involving 35 women, reported no significant difference in lower leg volume when compression stockings were compared against rest ( weighted mean difference -258.80, 95% CI -566.91 to 49.31). Another trial, involving 55 women, compared reflexology with rest. Reflexology significantly reduced the symptoms associated with oedema ( reduction in symptoms: RR 9.09, 95% CI 1.41 to 58.54). There was no evidence of significant difference in the women's satisfaction and acceptability with either intervention (RR 6.00, 95% CI 0.92 to 39.11). Authors' conclusions: Rutosides appear to help relieve the symptoms of varicose veins in late pregnancy. However, this finding is based on one small study (69 women) and there are not enough data presented in the study to assess its safety in pregnancy. It therefore cannot be routinely recommended. Reflexology appears to help improve symptoms for women with leg oedema, but again this is based on one small study (43 women). External compression stockings do not appear to have any advantages in reducing oedema.