Round Ligament Varicosities in Pregnancy Symptoms, Causes, Treatment

Pregnancy is the most common cause of round ligament varicosities (RLV), a condition that is not widely understood. Clinical examination alone is insufficient to tell the difference between RLV and an inguinal hernia. During pregnancy, round ligament varicosities must be closely monitored for rupture and acute variceal thrombosis. Painful swellings in the groin demand quick medical attention, and surgical examination may be necessary. It is important to note the difficulties in detecting inguinal swellings clinically during pregnancy in this scenario. 

During pregnancy, women with round ligament varicosities need to be closely monitored since it is possible for the varices to rupture and for acute variceal thrombosis to occur, particularly during the peripartum period.

Symptoms

The parauterine space to the labium Majora is connected by a circular ligament that comprises veins, arteries, lymphatics, and nerves. The round ligament contains dilated veins known as Round Ligament Varicosities. It is more likely to occur during pregnancy because of the increase in venous return and the decrease in venous tonus.

Swelling and soreness in the inguinal region are common symptoms of RLV, which can be brought on by an increase in intra-abdominal pressure. Varicosities of the round ligaments are a relatively unknown condition that is almost always brought on by pregnancy. Patients typically come with inguinal discomfort and edema. When the swelling hurts, the person likely has a strangulated inguinal hernia.

Causes

Pregnancy can cause varicose veins in some women, but they are usually innocuous. They occur when the uterus puts a lot of pressure on the large vein that brings blood from the feet and legs back to the heart. Pregnancy is the most common cause of round ligament varicosities (RLVs), which are relatively unknown. Round ligament varicosities cause groin swelling that resembles an inguinal hernia. The diagnosis becomes difficult because of this resemblance. Round ligament varicosities are uncommon, although increases in hormone levels during pregnancy can hasten their development. There is a relaxation of the smooth muscle in the veins, a rise in the amount of blood coming back from the legs, and a blockage of the veins in the pelvis caused by the pregnant uterus.

Treatment

It is easy to misdiagnose RLV as an inguinal hernia; therefore, ultrasound imaging is crucial for making the diagnosis. Ultrasound is the best way to diagnose RLV. It looks like a "bag of worms" on Gray-scale ultrasound, and it shows enlarged veins on Doppler imaging. To properly diagnose RLV, it is important to show that there are neither bowel loops nor swollen inguinal lymph nodes.

Treatment for round ligament varicosities is very different from treatment for inguinal hernias, so it is very important to make an accurate diagnosis of the patient's condition. Surgery is performed on symptomatic inguinal hernias during the second trimester of pregnancy; if the patient does not exhibit any symptoms, surgery is postponed. In contrast, round ligament varicosities are handled conservatively, with the assumption that they are spontaneously cured throughout the postpartum period. Analgesics that are suitable for use during pregnancy can be administered for pain relief in cases of continuous enlargement and significant discomfort.