maximum changes were seen in the superficial venous system in the thigh. The effect was more pronounced on the left and the changes in reflux returned to pre-pregnancy levels in the puerperium.

Objective MethodsTo examine changes in diameter and reflux in normal veins of the lower limb throughout pregnancy.Fifty-seven women were recruited into the study and 43 completed the full assessment to six weeks postpartum. Thirteen had pre-existing venous disease and are reported elsewhere. The veins were assessed in both lower limbs using colour flow duplex scanning. This was performed at a 75" tilt measuring vein diameter and the presence or absence of reflux. Measurements were made at 12, 20, 26,34,38 weeks of gestation and 6 weeks postpartum. ResultsNo new reflux developed in any of the veins studied. In the superficial system the maximum change was seen in the long saphenous vein at 34 weeks, on the left side the vein diameter failed to return to baseline size. Significant change also occurred in the superficial femoral vein. Dilatation of the deep veins of the calf was observed being greater in the left posterior tibia1 and the left peroneal at the mid-calf point. ConclusionColour flow duplex scanning is an acceptable method of assessing the lower limb veins in pregnancy. Maximum diameter changes were seen in the long saphenous vein and in the deep veins at mid-calf. No new reflux developed during the gestation period in veins which were previously normal.

Objective: To examine the associated features in pregnant women with superficial venous reflux, compared with those without reflux. Methods: Pregnant women were recruited at booking and underwent colour flow duplex ultrasound scanning of the lower limbs to ascertain the presence or absence of reflux in the superficial veins. Body mass index and CEAP scores were calculated. A questionnaire regarding parity, smoking habit and family history of varicose veins was administered. Statistical analysis was carried out using ARCUS. Results: Three hundred and twenty-nine women were recruited, of whom 83 were identified as having reflux (25%). No relationship was observed between reflux and obesity, smoking or family history. Multiparity was significantly correlated with varicose veins (p<0.03). CEAP scores were higher in multiparous women with varicose veins. An increase in symptoms was associated with a positive family history (especially maternal). Smoking was associated with fewer symptoms in those with reflux, as was obesity. Conclusion: Increased parity increased the likelihood of varicose veins, but obesity and family history appeared to make no difference. Symptoms were greater in multiparous women, but less inobese women. An association was made between smoking and fewer symptoms.

Objective: To assess the impact of changing from ascending phlebography to colour flow duplex (CFD) scanning for the investigation of deep vein thrombosis (DVT) in a District General Hospital and to determine the role of light reflection rheology (LRR) as a Preliminary screening tool for DVT. Design: Retrospective audit. Setting: Vascular Laboratory and Department of Radiology of the Countess of Chester Hospital, Chester, UK. Patients and methods: Audit and review of the all venograms done during the years 1989 to 1991 was undertaken. All the LRR and CFD scans done from 1991 (year of introduction in this hospital) to 1996 were audited and analysed. Outcome measures: Total number of various investigations done for suspected DVT in this hospital from 1989 to 1996 and their detailed analysis. Results: Four hundred and ninety-four venograms were performed between 1989 and 1991, of which 44% confirmed DVT. The least number of venograms was performed in 1991 ( n = 127), after the introduction of LRR. From 1991 through to 1996, the number of LRR scans increased from 90 to 697 and the CFD scans increased from 97 to 786. Conclusion: The audit revealed a 6-fold increase in demand for the examination of limbs for suspected DVT after the introduction of non-invasive tests. LRR continues to be a useful screening tool, reducing the number of CFD scans by 23%.

Despite the increasing use of D-dimers and clinical probability scoring in the preliminary investigation of thromboembolic events, LRR remains a viable alternative in safely risk-stratifying patients with suspected DVT.