Chronic Venous Disease in Pregnancy: Pathophysiology, Diagnostic Pitfalls, and a Trimester-Stratified Management Framework—A Narrative Review

Chronic venous disease (CVD) in pregnancy is common, poorly codified, and interpreted with diagnostic thresholds, severity instruments and treatment algorithms all derived outside pregnancy. This narrative review synthesises the mechanistic, epidemiological, diagnostic and therapeutic literature, keeping pregnancy-specific evidence separate from evidence extrapolated from non-pregnant populations. Gestational change is characterised principally by increased venous capacitance and vein-wall distension; ambulatory venous hypertension was not demonstrated in the two pregnancy studies assessing it; and new reflux develops in a minority, undetectable postpartum in the one study reporting it. Physiological adaptation, CVD and thrombotic pathology overlap clinically, deep vein thrombosis and superficial vein thrombosis being at once the principal differential diagnoses and potential complications. Management is correspondingly conservative: compression relieves symptoms but has not been shown to prevent varicose veins, routine initiation of venoactive drugs is not supported, and intervention is deferred other than in exceptional circumstances. A venous finding first detected in pregnancy warrants postpartum reassessment before it is taken for established disease. A trimester-stratified framework spanning preconception to late postpartum reassessment is proposed; it is evidence-informed rather than prospectively validated, and is not a guideline.