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1) Chaire d’Evaluation Ceren ESC & Dim CHRU Dijon, 2) économiste de la Santé, Cen Nutriment Dijon, 3) Angiologue, service d’Angiologie Hôpital Américain Neuilly F.A Allaert (1) UIP 2009 Observational study of the effect of compression stockings on venous symptoms and quality of life of pregnant women presenting a CEAP C0S to C3S venous insufficiency F. Vin Angiology Dpt American Hospital Neuilly F.A Allaert Chair of Medical Evaluation Ceren ESC & Dim CHRU Dijon, JC Colau, Gynecology Dpt , Foch Hospital Paris A. Virkus, N Oréac, Jobs BSN Medical

Uip Romain

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Page 1: Uip Romain

1) Chaire d’Evaluation Ceren ESC & Dim CHRU Dijon, 2) économiste de la Santé, Cen Nutriment Dijon,

3) Angiologue, service d’Angiologie Hôpital Américain Neuilly

F.A Allaert (1)

UIP 2009

Observational study of the effect of compression stockings on venous symptoms

and quality of life of pregnant women presenting a CEAP C0S to C3S venous

insufficiency

F. Vin Angiology Dpt American Hospital Neuilly

F.A Allaert Chair of Medical Evaluation Ceren ESC & Dim CHRU Dijon,

JC Colau, Gynecology Dpt , Foch Hospital Paris

A. Virkus, N Oréac, Jobs BSN Medical

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Pregnancy and venous disease

Pregnancy has a major impact on the venous system, initiating or increasing an existing venous insufficiency in many women

Various mechanisms may contribute

to this alteration of the venous function.

Major hormonal modifications : increase of estrogen promoting the appearance of oedema progesterone levels inducing an important vasodilatation.

Pregnancy has also an impact on the venous hemodynamic:

a greater sedentary inducing venous stasis and the compression of the pelvic veins by the gravid uterus.

These venous physical or functional troubles

generally increase throughout pregnancy.

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Wearing compression stockings regularly may impove to the venous system deficiency. Very few data are available in daily practice on the effect of wearing compression stockings : on venous pain of pregnant women on the quality of life of pregnant women

The objective of this prospective observational study was to describe and compare the evolution of the venous disease and quality of life of a group of pregnant women who were given the choice to accept or refuse wearing class II compression stockings.

Pregnancy and compression stockings

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Inclusion criteria The women were required to: 1) be pregnant, with an amenorrhoea period of at least 4 weeks and less than 28 weeks, 2) present a C0S to C3 CEAP venous disease requiring compression stockings proposed by their medical practitioner and 3) freely accept or refuse to wear them. Critères de non incusion past history of venous thromboembolism, do to the fact that they should absolutely accept to wear an elastic compression.

Methodology

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The study consisted of two visits: The first at the beginning of the pregnancy. the second at pregnancy term. During these two visits A CRF is filled by the medical practitioner or the midwife This CRF described the age of the women, number of previous pregnancies, venous history, venous status according the CEAP classification, functional symptoms, agreement or refusal to wear an elastic compression stockings (BSN medical Radiante-Jobst 20 mmHg) and any other venous therapies prescribed. A patient self questionnaire described:

their venous pain and discomfort on a visual analogic scale their quality of life evaluated with a specific questionnaire (CIVIQ).

STUDY FOLLOW UP

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165 pregnant women 32 years old

Acceptance rate is important when the medical benefit of wearing an elastic

compression is explained to the patient.

This acceptance doesn’t prejudge that the women will daily wear it, but at least 48.5 % of them wore it at least one day or two or more.

Near three-quarters of the women

accept to wear elastic stockings

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(p<0.05)

More the women have pain more they accept to wear compression stockings

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Pain on VAS:

Acceptance 58,4 vs refusal 46,1 (p<0.01)

Dyscomfort on VAS: Acceptance 30,9 vs refusal 18,9 (p<0.01).

The observation of high acceptance levels of wearing elastic

compression for pregnant women suffering from venous disease reflects more a symptomatic treatment attitude

than a real prevention action.

Information on the effect of pregnancy on the venous system must be reinforced

to the pregnant women as well as to the medical practitioner and midwifes who

may still have a passive attitude towards this risk.

More the women have pain more they accept to wear compression stockings

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Stabilization or improvement with elastic stockings worsening without elastic stockings

Evolution of leg pain

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Stabilization or improvement with elastic stockings worsening without elastic stockings

Evolution of leg heaviness

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Stabilization or improvement with elastic stockings worsening without elastic stockings

Evolution of leg oedema

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Stabilization or improvement with elastic stockings worsening without elastic stockings

Evolution of pain intensity

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Stabilization or improvement with elastic stockings worsening without elastic stockings

Evolution of dyscomfort intensity

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Stabilization or improvement with elastic stockings worsening without elastic stockings

In the group wearing no compression stockings, the functional and physical symptoms are worsened.

On the contrary, in the group wearing compression stockings, we observe a stabilization or an improvement of the frequency and of the inetensity of the symptoms.

Compression stockings appear to prevent venous disease worsening during pregnancy.

With Compression stockings : pain increases of 7,5 points. With Compression stockings : pain increases of 6,3 points (p<0.01).

These evolutions are not shown by the CIVIQ due to the fact that quality of life of pregnant women is not only influenced by venous disease…

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Conclusion

This observational study is one of the very few studies conducted in the venous disease of the pregnant women.

Its results describe the clinical increase of the venous symptoms during pregnancy.

and support the positive effect of wearing compression stockings throughout pregnancy to prevent, stabilize or reduce the functional and physical symptoms induced or increased by pregnancy.