Venous leg varicosities have a congenital predisposition and accrue with advancing age. They can be aggravated by factors that raise lower extremity venous pressures, such as an enlarging uterus. Femoral venous pressures in the supine gravida rise from 8 mm Hg in early pregnancy to 24 mm Hg at term. Thus, leg varicosities typically worsen as pregnancy advances, especially with prolonged standing. Symptoms vary from cosmetic blemishes and mild discomfort at the end of the day to severe discomfort that requires prolonged rest with feet elevation. Treatment is generally limited to periodic rest with leg elevation, elastic stockings, or both. Surgical correction during pregnancy generally is not advised, although rarely the symptoms may be so severe that injection, ligation, or even stripping of the veins is necessary.
Vulvar varicosities frequently coexist with leg varicosities, but they may appear without other venous pathology. Uncommonly, they become massive and almost incapacitating. If these large varicosities rupture, blood loss can be severe. Treatment is with specially itted pantyhose that will also minimize lower extremity varicosities. With particularly bothersome vulvar varicosities, a foam rubber pad suspended across the vulva by a belt can be used to exert pressure on the dilated veins.
Hemorrhoids are rectal vein varicosities and may irst appear during pregnancy as pelvic venous pressures rise. Commonly, they are recurrences of previously encountered hemorrhoids. Up to 40 percent of pregnant women develop these (Poskus, 2014). Pain and swelling usually are relieved by topically applied anesthetics, warm soaks, and stool-softening agents. With thrombosis of an external hemorrhoid, pain can be considerable. This may be relieved by incision and removal of the clot following injection of a local anesthetic.
Beginning early in pregnancy, many women experience fatigue and need greater amounts of sleep. his likely is due to the soporiic efect of progesterone but may be compounded in the irst trimester by nausea and vomiting. In the latter stages, general discomforts, urinary frequency, and dyspnea can be additive. Sleep duration may be related to obesity and gestational weight gain (Facco, 2016; Lockhart, 2015). Moreover, sleep eiciency appears to progressively diminish as pregnancy advances. Wilson and associates (201i1) performed overnight polysomnography and observed that women in the third trimester had poorer sleep eiciency, more awakenings, and less of both stage 4 (deep) and rapid-eye movement sleep. Women in the irst trimester were also afected, but to a lesser extent. Daytime naps and mild sedatives at bedtime such as diphenhydramine (Benadryl) can be helpful.