symptoms during pregnancy
women s health issues
Swelling During Late Pregnancy
Doctors must rule out deep vein thrombosis, preeclampsia, a heart disorder, and other possible causes before they can diagnose normal, physiologic edema. In pregnant women with swollen legs, the following symptoms are cause for concern: Moderate or severe swelling in the hands (hands look noticeably puffy and/or a ring cannot be removed from a finger) Swelling that suddenly increases in any part of the body Swelling in only one leg or calf, particularly if the area is warm, red, and/or tender or fever is present Blood pressure that is 140/90 mm Hg or higher Severe persistent headache, changes in vision, confusion, severe upper abdominal pain, or difficulty breathing—symptoms that may be caused by preeclampsia Chest pain or difficulty breathing—symptoms that may be caused by deep vein thrombosis Women should go to the hospital immediately if they have any of the warning signs. Women without warning signs should see a doctor, but a delay of several days is usually not harmful. Doctors first ask questions about the swelling and other symptoms and about the medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause of the swelling and the tests that may need to be done (see table). Doctors ask the following: When the swelling started How long it has been present Whether any activity (such as lying on the left side) lessens or worsens it Doctors also ask about conditions that increase the risk of developing Deep Vein Thrombosis (DVT) , Women are asked about other symptoms, which may suggest a cause. They are asked whether they have ever had deep vein thrombosis, Pulmonary Embolism (PE) , preeclampsia, high blood pressure, or heart problems, including cardiomyopathy. During the physical examination, doctors look for evidence of a serious cause of the swelling. To check for symptoms of preeclampsia, doctors measure blood pressure, listen to the heart and lungs, and may check the woman's reflexes and look at the back of her eyes with an ophthalmoscope (a handheld device that resembles a small flashlight). Doctors also look for areas of swelling, particularly in the legs, hands, and face. Any swollen areas are checked to see if they are red, warm, or tender. If preeclampsia is suspected, the protein level is measured in a urine sample, and a complete blood count, electrolytes, and tests of kidney and liver function are done. New-onset high blood pressure plus a high protein level in urine indicates preeclampsia. If the diagnosis is unclear, the woman is asked to collect her urine for 24 hours, and protein is measured in that volume of urine. High blood pressure with headache, changes in vision, abdominal pain, or abnormal blood or urine test results may also indicate preeclampsia. If deep vein thrombosis is suspected, Doppler ultrasonography of the affected leg is done. This test can show disturbances in blood flow caused by blood clots in the leg veins. If peripartum cardiomyopathy is suspected, electrocardiography, chest x-ray, echocardiography, and blood tests to check heart function are done. 