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Is round ligament varicosity in pregnancy a common precursor for the later development of inguinal hernias? The prospective analysis of 28 patients over 9 years

PURPOSE: Short-term effects of round ligament varicosity (RLV) in pregnancy have been investigated in small-scale studies. The long-term effects are unknown. This study aims to evaluate the risk of groin hernia manifestation after RLV in pregnancy, to delineate possible risk factors and to analyze t...

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Autores principales: Lechner, M., Bittner, R., Borhanian, K., Mitterwallner, S., Emmanuel, K., Mayer, F.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Paris 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7210230/
https://www.ncbi.nlm.nih.gov/pubmed/30900041
http://dx.doi.org/10.1007/s10029-019-01928-6
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author Lechner, M.
Bittner, R.
Borhanian, K.
Mitterwallner, S.
Emmanuel, K.
Mayer, F.
author_facet Lechner, M.
Bittner, R.
Borhanian, K.
Mitterwallner, S.
Emmanuel, K.
Mayer, F.
author_sort Lechner, M.
collection PubMed
description PURPOSE: Short-term effects of round ligament varicosity (RLV) in pregnancy have been investigated in small-scale studies. The long-term effects are unknown. This study aims to evaluate the risk of groin hernia manifestation after RLV in pregnancy, to delineate possible risk factors and to analyze the natural course of pregnancy and post-partum period with regard to RLV. METHODS: In a prospective analysis 28 pregnant women with RLV presented to the hernia clinic over 9 years. After clinical and ultrasound examination during pregnancy and publication of early results in 2013 a second structured follow-up was conducted. Demographic data, hernia-specific risk factors, comorbidities, pregnancy and birth-related data as well as post-partum period were documented without loss of follow-up. In these women, all pregnancies that occurred, including the ones without RLV, were analyzed. RESULTS: Median follow-up was 68 months (11.4–104.9). Only one groin hernia was found. No risk factors could be identified. After uncomplicated childbirth complaints subsided spontaneously in all but one patient within 4 weeks. Recurrence rates in subsequent pregnancies are up to 89%. CONCLUSION: Temporary RLV-induced dilation of the deep inguinal ring in pregnancy is not a common precursor for the development of inguinal hernias later in life. All findings support the theory that the hindrance of venous blood flow caused by the gravid uterus is an important contributing factor for RLV in pregnancy, which is self-limited but has a high risk of recurrence and is not an indication for surgery before or after delivery or for cesarean section.
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spelling pubmed-72102302020-05-13 Is round ligament varicosity in pregnancy a common precursor for the later development of inguinal hernias? The prospective analysis of 28 patients over 9 years Lechner, M. Bittner, R. Borhanian, K. Mitterwallner, S. Emmanuel, K. Mayer, F. Hernia Original Article PURPOSE: Short-term effects of round ligament varicosity (RLV) in pregnancy have been investigated in small-scale studies. The long-term effects are unknown. This study aims to evaluate the risk of groin hernia manifestation after RLV in pregnancy, to delineate possible risk factors and to analyze the natural course of pregnancy and post-partum period with regard to RLV. METHODS: In a prospective analysis 28 pregnant women with RLV presented to the hernia clinic over 9 years. After clinical and ultrasound examination during pregnancy and publication of early results in 2013 a second structured follow-up was conducted. Demographic data, hernia-specific risk factors, comorbidities, pregnancy and birth-related data as well as post-partum period were documented without loss of follow-up. In these women, all pregnancies that occurred, including the ones without RLV, were analyzed. RESULTS: Median follow-up was 68 months (11.4–104.9). Only one groin hernia was found. No risk factors could be identified. After uncomplicated childbirth complaints subsided spontaneously in all but one patient within 4 weeks. Recurrence rates in subsequent pregnancies are up to 89%. CONCLUSION: Temporary RLV-induced dilation of the deep inguinal ring in pregnancy is not a common precursor for the development of inguinal hernias later in life. All findings support the theory that the hindrance of venous blood flow caused by the gravid uterus is an important contributing factor for RLV in pregnancy, which is self-limited but has a high risk of recurrence and is not an indication for surgery before or after delivery or for cesarean section. Springer Paris 2019-03-21 2020 /pmc/articles/PMC7210230/ /pubmed/30900041 http://dx.doi.org/10.1007/s10029-019-01928-6 Text en © The Author(s) 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Article
Lechner, M.
Bittner, R.
Borhanian, K.
Mitterwallner, S.
Emmanuel, K.
Mayer, F.
Is round ligament varicosity in pregnancy a common precursor for the later development of inguinal hernias? The prospective analysis of 28 patients over 9 years
title Is round ligament varicosity in pregnancy a common precursor for the later development of inguinal hernias? The prospective analysis of 28 patients over 9 years
title_full Is round ligament varicosity in pregnancy a common precursor for the later development of inguinal hernias? The prospective analysis of 28 patients over 9 years
title_fullStr Is round ligament varicosity in pregnancy a common precursor for the later development of inguinal hernias? The prospective analysis of 28 patients over 9 years
title_full_unstemmed Is round ligament varicosity in pregnancy a common precursor for the later development of inguinal hernias? The prospective analysis of 28 patients over 9 years
title_short Is round ligament varicosity in pregnancy a common precursor for the later development of inguinal hernias? The prospective analysis of 28 patients over 9 years
title_sort is round ligament varicosity in pregnancy a common precursor for the later development of inguinal hernias? the prospective analysis of 28 patients over 9 years
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7210230/
https://www.ncbi.nlm.nih.gov/pubmed/30900041
http://dx.doi.org/10.1007/s10029-019-01928-6
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