Leg swelling in the last stages of pregnancy

Leg edema is more common in late pregnancy. Some edema may be the result of compression of the inferior vena cava by the enlarged uterus in the supine position, or obstruction of the outflow from both femoral veins. Leg edema may also be the result of deep vein thrombosis, which often develops during pregnancy. A hypercoagulable state occurs, and the woman becomes less mobile. Leg edema may be the result of preeclampsia, as well as pregnancy-related arterial hypertension.

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Diagnostics leg swelling in the last few weeks of pregnancy

When making a diagnosis, it is necessary to exclude deep vein thrombosis and preeclampsia. It is necessary to conduct a differential diagnosis with physiological edema.

Anamnesis

Common risk factors for deep vein thrombosis include venous insufficiency, trauma, pre-existing hypercoagulability disorder, cigarette smoking, immobility, and cancer. Common risk factors for preeclampsia include chronic hypertension, personal or family history of preeclampsia, age under 20 years, first pregnancy, multiple pregnancy, diabetes, vascular disorders, and hydatidiform mole. DVT may be suspected if unilateral swelling is present. Acute dyspnea may occur with pulmonary embolism due to deep vein thrombosis. Preeclampsia may be suspected if there is swelling of the face or hands (for example, if a ring no longer fits a finger). Also, symptoms that may suggest preeclampsia include headache, epigastric pain, other central or peripheral neurological disorders, visual impairment, and a tendency to bleed.

Clinical examination

Blood pressure is measured; hypertension (BP >140/90 mmHg) is typical of preeclampsia. Fundus changes, diffuse hyperreflexia, jaundice, petechiae, and purpura may also indicate preeclampsia. Unilateral leg redness, warmth, and tenderness suggest deep vein thrombosis.

Laboratory diagnostics

If preeclampsia is suspected, protein in the urine is measured. A urine protein test is performed, but if the diagnosis is unclear, the protein level in the 24-hour urine is measured. Arterial hypertension and proteinuria indicate preeclampsia. Other tests are performed based on the suspected clinical disorders.

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Treatment leg swelling in the last few weeks of pregnancy

Physiological swelling of the legs can be reduced by periodically lying on the left side, which reduces the pressure of the enlarged uterus on the inferior vena cava. Elastic therapeutic stockings are also used.