Swollen extremities (edema) during pregnancy

Reviewed by the BabyCenter Medical Advisory Board

Why are my ankles and feet so swollen?

What you're experiencing is edema — that's when excess fluid collects in your tissue. It's normal to have a certain amount of swelling during pregnancy because you're retaining more water. Changes in your blood chemistry also cause some fluid to shift into your tissue.

In addition, your growing uterus puts pressure on your pelvic veins and your vena cava (the large vein on the right side of the body that carries blood from your lower limbs back to the heart). The pressure slows the return of blood from your legs, causing it to pool, which forces fluid from your veins into the tissues of your feet and ankles.

Edema is most often an issue during the third trimester, particularly at the end of the day. It may be worse during the summer.

You can help relieve the increased pressure on your veins by lying on your side. Since the vena cava is on the right side of your body, left-sided rest works best.

After you have your baby, the swelling will disappear fairly rapidly as your body eliminates the excess fluid. You may find yourself urinating frequently and sweating a lot in the first days after childbirth.

When should I be concerned about swelling?

A certain amount of edema is normal in the ankles and feet during pregnancy. You may also have some mild swelling in your hands.

Call your midwife or doctor if you notice swelling in your face or puffiness around your eyes, more than slight swelling of your hands, or excessive or sudden swelling of your feet or ankles. This could be a sign of preeclampsia, a serious condition.

Also call your caregiver if you notice that one leg is significantly more swollen than the other, especially if you have any pain or tenderness in your calf or thigh.

What can I do to minimize the puffiness?

Here are a few tips:

• Put your feet up whenever possible. At work, it helps to keep a stool or pile of books under your desk. At home, lie on your left side when possible.
• Don't cross your legs or ankles while sitting.
• Stretch your legs frequently while sitting: Stretch your leg out, heel first, and gently flex your foot to stretch your calf muscles. Rotate your ankles and wiggle your toes.
• Take regular breaks from sitting or standing. A short walk every so often will help keep your blood circulating.
• Wear comfortable shoes that stretch to accommodate the swelling.
• Don't wear socks or stockings that have tight bands around the ankles or calves.
• Try waist-high maternity support stockings. Put them on before you get out of bed in the morning so blood doesn't have a chance to pool around your ankles.
• Drink plenty of water. Surprisingly, this helps your body retain less water.
• Exercise regularly, especially by walking, swimming, or riding an exercise bike. Or try a water aerobics class — immersion in water may temporarily help reduce swelling, particularly if the water level is up near your shoulders.
• Eat well, and avoid junk food.

Try not to let pregnancy swelling get you down. The sight of your swollen ankles will probably add to your feeling of ungainliness, but edema is a temporary condition that will pass soon after you give birth.

Negative pressure pulmonary edema following naloxone administration in a patient with fentanyl-induced respiratory depression.

Sept 2010

Horng HC, Ho MT, Huang CH, Yeh CC, Cherng CH.

Source

Division of Anesthesiology, Taichung Armed Forces General Hospital, Taichung, Taiwan, Republic of China.

Abstract

Naloxone is commonly used to reverse narcotic intoxication. However, its use is not entirely free of hazards. For instance, pulmonary edema (PE) has been reported to arise with the mechanism of over-sympathetic discharge caused by release of cat-echolamine or central neurogenetic responses to narcotic reversal. Here, we report a healthy young patient who, after undergoing an uneventful uvulopalatopharyngo-plasty for obstructive sleep apnea hypopnea syndrome, developed PE following administration of naloxone. Fentanyl-induced respiratory depression was found during anesthesia emergence and thus naloxone was indicated for reversal. Unfortunately, upper airway obstruction-induced negative pressure PE occurred following naloxone administration. From this case, we suggest that a patent airway should be ascertained before naloxone administration for treating narcotic-induced respiratory depression.

Elsevier

Naloxone-induced pulmonary edema : Case report with review of the literature and critical evaluation

Feb 2012

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[Article in German]

Lassen CL, Zink W, Wiese CH, Graf BM, Wiesenack C.

Source

Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Regensburg, Deutschland, christoph.lassen@klinik.uni-regensburg.de.

Abstract

A case of pulmonary edema after the administration of naloxone for laparoscopic splenectomy is reported. Previous reports of naloxone-induced pulmonary edema are listed and reviewed. The clinical course is compared to other forms of non-cardiogenic pulmonary edema. Uncertainty remains about the underlying pathophysiological process and the true impact of naloxone on the development of pulmonary edema.

PubMed

Ranibizumab: in diabetic macular oedema.

Mar 2012

Frampton JE.

Source

Adis, Auckland, New Zealand.

Abstract

Ranibizumab, an intravitreally administered inhibitor of vascular endothelial growth factor (VEGF), is approved for the treatment of visual impairment associated with diabetic macular oedema (DME) in the EU. In four well designed, phase II or III trials (RESOLVE, RESTORE, RIDE and RISE), 1-2 years' treatment with ranibizumab was more effective than sham or focal/grid laser therapy in improving best corrected visual acuity (BCVA) and reducing central retinal thickness (CRT) in patients with visual impairment associated with DME. Additionally, in two well designed phase III trials (RESTORE and DRCR.net-1), 1 year of treatment with ranibizumab as an adjunct to laser therapy was more effective than laser monotherapy in improving BCVA and CRT in patients with visual impairment associated with DME. Improvements in BCVA with ranibizumab alone or as an adjunct to laser therapy were observed at the first follow-up visits in these studies (i.e. 1-4 weeks after the start of treatment), and were associated with gains in vision-related quality of life, as assessed using the National Eye Institute Visual Functioning Questionnaire-25. The ocular and non-ocular adverse event profile of ranibizumab in patients with DME is similar to that observed in patients with neovascular (wet) age-related macular degeneration or retinal vein occlusion. Based on tolerability data from clinical trials, there is no indication that ranibizumab alone or combined with laser is associated with an increased risk of cardiovascular or cerebrovascular events potentially related to systemic VEGF inhibition.

PubMed

Nail Disease in Psoriatic Arthritis: Distal Phalangeal Bone Edema Detected by Magnetic Resonance Imaging Predicts Development of Onycholysis and Hyper

Nail Disease in Psoriatic Arthritis: Distal Phalangeal Bone Edema Detected by Magnetic Resonance Imaging Predicts Development of Onycholysis and Hyperkeratosis.

Dalbeth N, Pui K, Lobo M, Doyle A, Jones PB, Taylor WJ, McQueen FM.

Source

From the Department of Medicine, University of Auckland, Auckland; Department of Rheumatology, Auckland District Health Board, Auckland; Department of Anatomy with Radiology, University of Auckland, Auckland; Department of Medicine, University of Otago, Wellington; and Department of Molecular Medicine, University of Auckland, Auckland, New Zealand.

Abstract

OBJECTIVE:

To examine the association between magnetic resonance imaging (MRI) features of distal phalanx (DP) disease and the progression of nail pathology in psoriatic arthritis (PsA).

METHODS:

Clinical nail assessment and hand MRI scans were done on 34 patients with PsA. Twenty patients had repeat nail assessments after 1 year.

RESULTS:

Nails with onycholysis and hyperkeratosis at baseline were more likely to have corresponding DP bone erosion and proliferation on MRI. DP bone edema on baseline MRI was associated with development of onycholysis and hyperkeratosis in corresponding nails.

CONCLUSION:

Our data suggest that DP inflammation is central in the development of psoriatic nail disease.

PubMed

Validating Imaging Biomarkers of Cerebral Edema in Patients with Severe Ischemic Stroke.

Feb 2012

Yoo AJ, Sheth KN, Kimberly WT, Chaudhry ZA, Elm JJ, Jacobson S, Davis SM, Donnan GA, Albers GW, Stern BJ,González RG.

Source

Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.

Abstract

BACKGROUND:

There is no validated neuroimaging marker for quantifying brain edema. We sought to test whether magnetic resonance imaging (MRI)-based metrics would reliably change during the early subacute period in a manner consistent with edema and whether they would correlate with relevant clinical endpoints.

METHODS:

Serial MRI studies from patients in the Echoplanar Imaging Thrombolytic Evaluation Trial with initial diffusion-weighted imaging (DWI) lesion volume >82 cm(3) were analyzed. Two independent readers outlined the hemisphere and lateral ventricle on the involved side and calculated respective volumes at baseline and days 3 to 5. We assessed interrater agreement, volume change between scans, and the association of volume change with early neurologic deterioration (National Institutes of Health Stroke Scale score worsening of ≥4 points), a 90-day modified Rankin scale (mRS) score of 0 to 4, and mortality.

RESULTS:

Of 12 patients who met study criteria, average baseline and follow-up DWI lesion size was 138 cm(3) and 234 cm(3), respectively. The mean time to follow-up MRI was 62 hours. Concordance correlation coefficients between readers were >0.90 for both hemisphere and ventricle volume assessment. Mean percent hemisphere volume increase was 16.2 ± 8.3% (P < .0001), and the mean percent ventricle volume decrease was 45.6 ± 16.9% (P < .001). Percent hemisphere growth predicted early neurologic deterioration (area under the curve [AUC] 0.92; P = .0005) and 90-day mRS 0 to 4 (AUC 0.80; P = .02).

CONCLUSIONS:

In this exploratory analysis of severe ischemic stroke patients, statistically significant changes in hemisphere and ventricular volumes within the first week are consistent with expected changes of cerebral edema. MRI-based analysis of hemisphere growth appears to be a suitable biomarker for edema formation

Unilateral Pulmonary Edema: A Rare Initial Presentation of Cardiogenic Shock due to Acute Myocardial Infarction.

Feb 2012

Shin JH, Kim SH, Park J, Lim YH, Park HC, Choi SI, Shin J, Kim KS, Kim SG, Hong MK, Lee JU.

Source

Division of Cardiology, Hanyang University Guri Hospital, Guri, Korea.

Abstract

Cardiogenic unilateral pulmonary edema (UPE) is a rare clinical entity that is often misdiagnosed at first. Most cases of cardiogenic UPE occur in the right upper lobe and are caused by severe mitral regurgitation (MR). We present an unusual case of right-sided UPE in a patient with cardiogenic shock due to acute myocardial infarction (AMI) without severe MR. The patient was successfully treated by percutaneous coronary intervention and medical therapy for heart failure. Follow-up chest Radiography showed complete resolution of the UPE. This case reminds us that AMI can present as UPE even in patients without severe MR or any preexisting pulmonary disease affecting the vasculature or parenchyma of the lung.

PubMed

Posttraumatic Anomalous Pulmonary Edema.

Feb 2012

Henry TS, Mettenburg JM, Cummings KW, Bhalla S.

Source

*Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA †Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO.

Abstract

Focal pulmonary edema from increased venous hydrostatic pressure is most commonly seen in mitral valve regurgitation (in the right upper lobe) or in pulmonary venous obstruction/compression from neoplastic, fibrotic, or iatrogenic causes (in any lobe). We describe a case of focal pulmonary edema of the left upper lobe in a patient with partial anomalous pulmonary venous return of the left superior pulmonary vein, where the draining left brachiocephalic vein was compressed by a subluxed sternoclavicular joint after trauma. In this case, recognition of the focal edema and anomalous pulmonary vein allowed for a diagnosis of clavicular subluxation.

Lippincott, Williams, Wilkins