Compression stocking prevents increased venous retrograde flow time in the lower limbs of pregnant women

Evaluation of Elastic Venous Compression Device dispensation in pregnant and post-partum women using the French National Health Insurance Claims Database: The ProFIL retrospective cohort study

OBJECTIVES

To describe the real-world use of Elastic Venous Compression Devices (EVCDs) during pregnancy and post-partum using data from a representative subset of the French National Health Insurance Claims Database (the Echantillon Généraliste des Bénéficiaires, EGB).

STUDY DESIGN

Women aged 15-49 who were pregnant between 1st July 2017 and 15th June 2018 were identified in the EGB using pregnancy-specific acts (certain prenatal examinations or deliveries). Subgroups were defined by age, presence of Venous Thrombo-Embolism (VTE) risk factors, history of VTE, delivery type and time period. EVCD dispensations (format, prescriber, and date) were identified among those for "standard orthotics" using their unique reimbursement tariffs. Dispensation rates were computed for all subgroups, overall and by format and were compared.

RESULTS

15,528 pregnant women were included: 7,252 [46.7 %] deliveries (5,796 vaginal [79.9 %], 482 planned cesarean sections (C-sections) [6.7 %] and 974 unplanned C-Sections [13.4 %]), 2,734 (17.6 %) terminations and 5,542 (35.7 %) unknown outcomes. Overall, 4,919 (31.7 %) women were dispensed at least one EVCD. Ante-partum dispensation occurred in 43.1 % (n = 3,122) of women whose pregnancy led to a delivery. Dispensation rates were 17.3 % (n = 1,005), 46.7 % (n = 225) and 44.1 % (n = 430) after vaginal delivery, planned C-sections or unplanned C-sections, respectively. Overall, dispensation rates significantly increased with age, the presence of VTE risk factors, and a history of VTE (p < 0.01). EVCD dispensation was most frequent (17.0 %) during the 5th month of pregnancy. Among pregnant women who were dispensed at least one EVCD during ante- or post-partum, 69.0 % had one or two units of compression (27.1 % [one unit], 41.9 % [two units]). Stockings (48.6 %, n = 6,038) were dispensed significantly more frequently than socks (36.9 %, n = 4,586) and tights (14.5 %, n = 1,806) (p < 0.01). The main contributors to mechanical VTE prophylaxis were gynecologists (26.3 % of dispensations, n = 2,280), general practitioners (20.2 %, n = 1,749) and midwives (15.1 %, n = 1,314).

CONCLUSIONS

Low observed dispensation rates highlight a discrepancy between the French National Authority for Health (Haute Autorité de Santé, HAS), recommending EVCDs use during pregnancy and after delivery, and the real-life use of EVCD. Prescription sensitization combined with targeted information campaigns for pregnant women would be beneficial to contribute to the prevention of VTE, a health problem for pregnant women.

Fast NURBS-based parametric modeling of human calves with high-accuracy for personalized design of graduated compression stockings

BACKGROUND AND OBJECTIVES

Accurate human body models are increasingly demanded by high-quality human-centered ergonomic applications, especially the design and manufacturing of compressive functional apparels. However, existing parametric models in related works are not capable to accurately describe detailed local shape features of human.

METHODS

In this work, a high-accuracy parametric modeling approach for human limb was proposed. 3D Scans of human calves were studied. Key data points of the scanned human calves were identified according to human anatomy, forming a quasi-triangular mesh of feature points. Then, non-uniform rational B-splines (NURBS) method was implemented. Control points were calculated from the key data points, with which the human calf shapes can be reconstructed by the smooth NURBS surface, giving rise to a new parametric model of human calves. Error between the scanned and reconstructed calf shapes were analyzed to verify the effectiveness of this model.

RESULTS

Error analysis showed that, this proposed method delivers a high-efficiency and high-accuracy parametric shape modeling approach with averaged error observed as only 0.37% for all the 260 subjects, much less compared to previous relative works (around 5%). For tentative application, customized medical compression stockings were designed based on this model and proved as valid to exert desired gradient compression on the according calf mannequin.

CONCLUSIONS

By introducing the non-uniform rational B-splines method, a parametric model capable of characterizing human limbs with high-accuracy was proposed. Using very small amount of data, this model is expected to highly facilitate remote customized design and provide 3D shape references for design of compressive garments. Moreover, the proposed methods can inspire developments of other mixed modeling methods for high-accuracy applications.

Percepção positiva e eficácia das meias de compressão na prevenção de edema em membros inferiores de gestantes

Background

Pregnancy is characterized by physiological changes that can contribute to development of varicose veins, venous insufficiency, and leg edema.

Objectives

To evaluate the effect of compression stocking on lower limb edema in pregnant women and their perceptions of wearing them.

Methods

This was a randomized, controlled, prospective, parallel, blinded clinical trial conducted with 60 pregnant women randomly distributed into two groups: an intervention group (n = 30) wearing compression stockings and a control group (n = 30). Standardized ankle and calf measurements were taken of all 120 lower limbs using a tape measure. At the end of the study, a questionnaire was administered to identify perceived difficulties and advantages related to wearing compression stockings.

Results

Pregnant women in the intervention group had a significantly smaller increase (p < 0.05) in calf and ankle diameters compared to those in the control group. The mean differences from the beginning to the end of gestation in the diameters of the right calf, left calf, right ankle, and left ankle respectively were 0.30 cm, 0.30 cm, 0.15, cm and 0.15 cm in the intervention group and 1.95 cm, 1.95 cm, 1.73 cm, and 1.87 cm in the control group. Most of the pregnant women had no difficulty wearing the compression stockings and all reported that they felt a difference in leg symptoms and would wear stockings again.

Conclusions

Compression stockings were effective for preventing lower limb edema in pregnant women, who had a positive perception of wearing them.