[Ultrasonographic examination of major veins of lower limbs and pelvic veins in pregnant women]. / Ul'trazvukovoe issledovanie magistral'nykh ven nizhnikh konechnostei i ven taza u beremennykh zhenshchin.

The problem of chronic venous insufficiency in women during pregnancy is of current concern. A total of 115 pregnant women in the first, second and third trimesters of gestation were examined in a stage-wise manner. During the first stage we conducted a comprehensive clinical study with the obligatory consultation by the obstetrician-gynaecologist. At the second stage, all women were subjected to ultrasonographic examination of the venous system of both lower extremities and the small pelvis. Studying the diameters of the deep veins of the right and left lower limbs, as well as the paired veins of the small pelvis demonstrated no statistically significant differences, which made it possible to evaluate these parameters as a whole. In all pregnant women, the lumen of the examined vessels was uniform, with the veins being patent, compliant, stained on colour Doppler mapping. Respiration-synchronized, phasic blood flow was registered. In the course of the study it was revealed that the diameter of the veins of the lower limbs and small pelvis increased as gestation proceeded. The findings of ultrasonographic angioscanning showed that by the third trimester of pregnancy the diameter of the femoral vein was 1.5-fold larger and that of the popliteal vein was 1.4-fold larger. The diameter of the veins of the pampiniform plexus of the ovaries during gestation was noted to have increased 1.13-fold. This was accompanied and followed by deterioration of tonic-and-elastic properties of the venous wall and the development by the third trimester of valvular insufficiency with the emergence of venous congestion. Seventeen (16%) women were found to have varicose syndrome. The above mentioned alterations of venous haemodynamics appeared to lead to impairment of blood flow in the affected veins and to the emergence of thrombogenic zones in the valvular sinuses. Of the 115 women examined, 77 (67%) were found to have degree 1 sludge and 36 (31.3%) had degree 2 sludge, with the D-dimer level in these women having increased to 773.3±37.5 ng/ml. Degree 3 sludge was observed in 2 (1.7%) women previously operated on for acute venous thrombosis. Their D-dimer level amounted to 954.3±43.2 ng/ml. It was demonstrated that studying the valvular sinuses for detection of sludge during examination of pregnant women allowed obstetricians-gynaecologists and physicians of ultrasonographic diagnosis to form risk groups for the development of deep vein thrombosis and to timely take appropriate measures aimed at prevention of the pathology concerned.

[Method of preventive ultrasound diagnosis of venous thrombosis]. / Metod preventivnoi ul'trazvukovoi diagnostiki venoznykh trombozov.

AIM: The purpose of the study was to work out a method of preventive diagnosis of venous thromboses by means of ultrasonographic duplex scanning (USDS). PATIENTS AND METHODS: A total of 306 people were examined. Of these, 146 patients presented with acute venous thrombosis, 108 subjects suffered from varicose veins, and 52 were apparently healthy people composing the control group. All those enrolled into the study were examined by means of USDS, with the D-dimer level determined. RESULTS: The obtained findings made it possible to discover and duly describe an ultrasonographic phenomenon of the presence of echo-positive inclusions in the zone of valvular sinuses, which was called the phenomenon of spontaneous echo contrast (SEC). This was followed by working out a classification of this phenomenon, describing two degrees thereof. Degree 1 SEC reflects the fact that the area of valvular sinuses is the most thrombogenic zone. Degree 2 SEC is characterised as a pathological, being simultaneously pre-thrombotic, condition and may serve as one of the earliest predictors of the development of venous thrombosis. A close correlation was established between the degree 2 SEC phenomenon, the presence of venous thrombosis and the values of the D-dimer level (r=0.89, p<0.01). CONCLUSION: Ultrasonographic examination of valvular sinuses is a simple, readily available and reproducible method of screening and may thus be used for preventive diagnosis of acute venous thromboses. The findings of this study make it possible to form risk groups by the development of deep vein thrombosis, as well as to initiate timely measures on prevention of the pathology concerned.