RESUMO
The authors give the pattern of several situations where are added phlebological and gynecological diseases. They summarize the several treatments and the practical uses for this. Medicolegal viewpoints are also taken in account.
PIP: 3 areas in which gynecological factors affect phlebology and especially the venous system of the lower extremities are discussed. The presence of small or moderate varices does not contraindicate use of oral contraceptives (OCs), but venous tonics or even anticoagulants should be administered under specific circumstances in women with a tendency toward thrombosis. OCs should be avoided in women with significant venous lesions. If OCs are imperative, the varices should be treated before OC administration is initiated. Women whose syndrome of venous stasis worsens during menstruation or OC use should be carefully examined for gynecological lesions. If no lesions are found and treated, the OCs should be replaced by a nonhormonal method of contraception or the cause of the venous insufficiency should be further explored. OCs should be temporarily suspended for women undergoing sclerotic treatment of their varicosities. Alternatively, limited interventions such as ambulatory phlebectomies under heparin therapy can be substituted, but in these cases stripping should be avoided because of the danger of deep venous thrombosis. The practitioner contemplating treatment of varicosities in women using OCs should bear in mind the possibility of a malpractice charge if phlebitis should develop. The appearance of varices of varicosities accompanied by a peripheral venous stasis syndrome can be 1 of the 1st signs of pregnancy. Such varices in pregnant women represent small exteriorizations of enormous venous dilatations in the pelvis. They are almost never hemorrhagic during delivery and regress rapidly in the postpartum. Their thrombosis, however, can be very grave when it does occur. Varices of pregnancy which do not regress within 3 months' postpartum will be permanent. Different interventions are necessary in the case of preexisting significant varicosities or complicated varicosities during pregnancy. The usual treatments combine support and heparin therapy. The presence of varices does not absolutely contraindicate gynecological interventions. But OCs are formally contraindicated in the case of women with histories of deep phlebitis with sequelae.