Primary varicose veins of the inguinal canal as one of the forms of atypical varicose veins during pregnancy, mimicking the inguinal hernia (clinic, diagnostics)

Abstract

In a certain number of pregnant women during gestation, the so-called, according to V. I. Medved, "pregnancy-associated pathology" occurs and manifests itself as an extragenital lesion of organs and systems, which requires additional competence of a specialist not an obstetrician-gynecologist. One of the manifestations of such a problem is the gestational debut of chronic venous disease, which occurs against the background of changes in the female body and is considered as a "normal adaptation of pregnancy". in some cases, it turns into a new quality – pathology]. One of the manifestations of this pathology is varicose veins in the inguinal canal. It is described in most literature sources as varicose veins of the round ligaments of the uterus (VVRLU) or varicocele of the round ligaments of the uterus Primary varicose veins of the inguinal canal (PVVІС), which occur during pregnancy, is one of the poorly studied problems of women's health, This pathology in some cases mimics the inguinal hernia, which sometimes involves unreasonable surgical interventions. Purpose of the study. To study the frequency of PVVІС and the effect of their exclusion during pregnancy on fetal development. Materials and methods. We analyzed 568 patients who underwent treatment, outpatient observation and gave birth in 2013-2025 on the basis of the municipal institution "Rivne Regional Perinatal Center" of the Rivne Regional Council. All patients were examined by the clinic of the PVVPK. All pregnant women underwent a duplex ultrasound examination (DUZE) with the performance of a compression test of veins in the inguinal canal in accordance with the protocol developed by us, In 470 pregnant women, in the second and third trimester, arterial hemodynamics in the uterine arteries, umbilical cord artery and midcerebral arteries of the fetus were studied in dynamics before and after the compression test using duplex ultrasound scanning by the VOLUSON E&EXPERT device according to the resistance index (IR). Fetal cardiac activity and uterine tone in pregnant women were studied using cardiotocography (CTG) data according to Fisher (1976) obtained using the Sonicard team cre v. 7. 43 apparatus (Germany). Results of the study and their discussion. According to our data, the frequency of this pathology is 5 cases per 1000 pregnant women. The results obtained showed that varicose veins in the inguinal canals occur in a certain number of pregnant women only during pregnancy and progress during subsequent pregnancies. In 82. 3% of patients, pain was calculated, according to the subjective assessment of patients for ASA of 23-49 mm, in 14. 7%, respectively, in 50-68 mm, which required periodic use of painkillers, and in 3% pain was estimated at 70-78 mm, which required constant use of painkillers. In patients of the second and third trimesters, during a compression test, which simulated the exclusion of inguinal veins from venous blood flows, in dynamics before and after the test, there were no disorders of arterial blood flow in the uterine arteries, umbilical cord, midcerebral artery of the fetus, no indicators of cardiac activity of the sex according to CTG data were detected Conclusions. According to our data, the frequency of this pathology is 5 cases per 1000 pregnant women. Varicose veins of the inguinal canal, which occurs in an isolated form, can mimic the clinic of an inguinal hernia, as well as varicose veins of the external genital organs, varicose veins of the lower extremities. These veins are abnormal in nature and perform a slight drainage venous function mainly from the veins of the pregnant uterus, do not affect blood flow in the arteries of the fetus when they are excluded.