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. Treatments for
varicose veins are usually divided into three main groups: surgery, pharmacological and non-pharmacological treatments. Treatments of leg oedema comprise mostly symptom reduction rather than cure and use of pharmacological and non-pharmacological approaches.
OBJECTIVES: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2015) and reference lists of retrieved studies.
SELECTION CRITERIA: Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy.
MAIN RESULTS: We included seven trials (involving 326 women). The trials were largely unclear for selection bias and high risk for performance and detection bias.Two studies were placebo-controlled trials. The first one compared a phlebotonic (
rutoside) with placebo for the reduction in symptoms of
varicose veins; the second study evaluated the efficacy of
troxerutin in comparison to placebo among 30 pregnant women in their second trimester with symptomatic vulvar varicosities and
venous insufficiency in their lower extremities. Data from this study were not in useable format, so were not included in the analysis. Two trials compared either
compression stockings with resting in left lateral position or
reflexology with rest for 15 minutes for the reduction of leg oedema. One trial compared standing water immersion for 20 minutes with sitting upright in a chair with legs elevated for 20 minutes. Women standing in water were allowed to stand or walk in place. One trial compared 20 minutes of daily foot
massage for five consecutive days and usual
prenatal care versus usual
prenatal care. The final trial compared three treatment groups for treating leg oedema in pregnancy. The first group was assigned to lateral supine
bed rest at room temperature, women in the second group were asked to sit in a bathtub of waist-deep water at 32 ± 0.5 C with their legs horizontal and the third group included the women who were randomised to sitting immersed in shoulder-deep water at 32 ± 0.5 C with legs extended downward. We did not include this study in the analysis as outcomes reported in the paper were not pre-specified outcomes of this review.We planned to use GRADE methods to assess outcomes for two different comparisons and assign a quality rating. However, only two out of three outcomes for one comparison were reported and could be assessed. Evidence from one trial (
rutoside versus placebo) for the outcomes of reduction in symptoms and incidence of complications associated with
varicose veins and oedema was assessed as of moderate quality.
Rutoside versus placeboOne trial involving 69 women, reported that
rutoside significantly reduced the symptoms associated with
varicose veins (risk ratio (RR) 1.89, 95% confidence interval (CI) 1.11 to 3.22; moderate quality evidence). The incidence of complications (
deep vein thrombosis) did not differ significantly between the two groups (risk ratio (RR) 0.17, 95% CI 0.01 to 3.49; moderate quality evidence). There were no significant differences in side-effects (RR 1.30, 95% CI 0.23 to 7.28). Women's perception of
pain was not reported in this trial. External pneumatic intermittent compression versus restOne trial, involving 35 women, reported no significant difference in lower leg volume when
compression stockings were compared against rest (mean difference (MD) -258.80, 95% CI -566.91 to 49.31).
Reflexology versus restingAnother 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). The same study showed a trend towards satisfaction and acceptability with the intervention (RR 6.00, 95% CI 0.92 to 39.11). Water immersion versus leg elevationThere was evidence from one trial, involving 32 women, to suggest that water immersion for 20 minutes in a swimming pool reduces leg volume (RR 0.43, 95% CI 0.22 to 0.83). Foot
massage versus routine careOne trial, involving 80 women reported no significant difference in lower leg circumference when foot
massage was compared against routine care (MD -0.11, 95% CI -1.02 to 0.80).No other primary or secondary outcomes were reported in the trials.
AUTHORS' CONCLUSIONS: