Edema during pregnancy can be physiological or pathological. Observed with preeclampsia, compression of large vessels by the uterus, diseases of the kidneys, heart and blood vessels, some hypovitaminosis, endocrine diseases. They are more often detected in the distal extremities, especially the lower ones. Less commonly found on the face or spread throughout the body. They are diagnosed on the basis of an external examination, special calculations. The cause is established using hardware techniques, laboratory tests. Treatment includes diet, diuretics, antispasmodics, antihypertensives, antiplatelet agents, and other drugs. The birth plan is determined individually.
Edema during pregnancy can be detected both in normal conditions and in the development of various pathological conditions. The tendency to swelling during this period is due to an increase in the level of progesterone, an increase in the amount of fluid in the body. In pregnant women, compared with non-pregnant women, the volume of fluid increases by 6-8 liters, 4-6 of which are contained in the placenta, amniotic fluid, fetus, and the remaining 2-4 are distributed throughout the body.
The causes of this manifestation during pregnancy are:
Patients of small stature tend to develop edema. The predisposing factor is excess weight. In girls with a slight excess of body weight, pastosity appears more often, but does not reach a significant degree of severity. In patients with severe obesity, the tendency to peripheral edema increases, the symptom becomes permanent, combined with shortness of breath, pain in the spine, joints of the legs.
Puffiness is characteristic of all late toxicoses, which, in essence, are successive stages of one pathological process. The change of stages can be both gradual and lightning fast, which makes it important to take into account the severity of the symptom, other manifestations to determine the severity of the condition, the need for urgent measures. The following variants of gestosis are possible:
As a rule, it is diagnosed after the 25th week of pregnancy. Manifested by tachycardia, weakness, shortness of breath, increased fetal movement in the supine position. Cardialgia, fear, anxiety, visual disturbances, noise and ringing in the ears are detected. Postural hypotension develops, sometimes fainting. Edema in the IVC syndrome is found on the lower extremities, due to the deterioration of the outflow of blood against the background of compression of a large venous trunk.
An increased likelihood of edema during pregnancy is noted in women with a single kidney due to organ agenesis or after nephrectomy. An increase in the load on the urinary system can lead to morning swelling of the face, a decrease or increase in urination, the appearance of blood impurities, and cloudy urine. The general condition worsens, drowsiness, weakness, fatigue are observed. There is a high probability of developing gestational pyelonephritis, which is manifested by dysuria, severe pain similar to renal colic.
Glomerulonephritis occurs against the background of infections, toxic effects, systemic pathologies. In the acute form of the disease, the face and eyelids suddenly become swollen, weakness, hyperthermia, chills, appetite disorders, and back pain are observed. Urination decreases, urine becomes brown, red or pink.
In more than half of the patients, glomerulonephritis during pregnancy is chronic. Edema syndrome is pronounced in 5% of patients. It may involve the face, hands, feet. In severe cases, swelling spreads to the whole body, anasarca develops. The presence of ascites is indicated by a rapid increase in the abdomen. Increasing shortness of breath is a sign of hydrothorax.
In 60-80% of cases, varicose veins are provoked by pregnancy, in other women it is aggravated due to the increased load on the vessels. It usually affects the lower extremities. At the initial stage, a slight pastiness occurs in the evening, especially after prolonged standing, combined with a feeling of heaviness, a “buzz” in the legs. Subsequently, pain, local convulsions appear. Severe swelling of the feet, ankles, lower legs indicates damage to the deep veins.
A rare variant of the disease is genital varicose veins. Possible swelling of the labia and perineum, blood smearing after sexual intercourse, itching, heaviness, bursting in the genital area. There are aching and pulling pains in the lower abdomen and genitals, radiating to the groin, sacrum, lower back.
The pathological condition is caused by disorders of the blood coagulation system, accompanied by the formation of blood clots. The most common complication of thrombophilia during pregnancy is thrombophlebitis. Swelling of the leg with deep venous thrombosis is combined with arching pains, cyanosis of the skin, swelling of the superficial veins, an increase in local temperature, thickening, and soreness of the damaged vessel. Due to thrombosis of the vessels of the placenta, severe preeclampsia develops with massive edema of the abdomen, upper and lower extremities.
In two-thirds of women, it is provoked by pregnancy, after the birth of a child, blood pressure returns to normal. There is an increased tendency to edema of the distal legs. Possible swelling of the hands. The main manifestations of hypertension during pregnancy are dizziness, tinnitus, headaches, fatigue, shortness of breath, tachycardia.
The main cardiac cause of edema during pregnancy is considered to be circulatory failure in rheumatic or congenital heart defects. The lower extremities swell mainly: shins, feet, ankle joints. Drowsiness, muscle weakness, fatigue, interruptions in the work of the heart, shortness of breath, a bluish tint or pallor of the skin are observed. A more rare cardiac pathology that provokes the development of edema is dilated cardiomyopathy.
Quite common in pregnant women, iodine deficiency causes edema only when the level of thyroid hormones decreases. In severe cases, clinically pronounced hypothyroidism develops. The most noticeable edema is observed on the face and neck, sometimes covering the entire body. The face is mask-like, puffy. There are no skin color changes or pressure marks. Rapid weight gain, lethargy, constipation, nausea, deterioration of hair and nails are found.
Edema, convulsions, lethargy, early toxicosis are observed in pregnant women with hypovitaminosis B6. These symptoms are exacerbated by concomitant deficiency of vitamins B9 and B12. The development of a specific clinical picture is preceded by apathy, weakness, drowsiness, loss of appetite, deterioration in concentration, and a tendency to colds.
The obstetrician-gynecologist is engaged in determining the cause of the symptom during pregnancy. According to the indications, the patient is referred for consultations to a nephrologist, phlebologist, cardiologist, and other specialists. The survey is carried out using the following methods:
Depending on the cause of the symptom, the following therapeutic measures are carried out:
Natural childbirth is usually the preferred option. If necessary, a caesarean section, small obstetric operations are performed. Sometimes early delivery is required. Specific surgical treatment, if possible, is postponed until the end of pregnancy or lactation. Patients with varicose veins, according to indications, undergo crossectomy, miniphlebectomy, endovasal laser coagulation. Minimally invasive methods of treating heart defects are closed mitral commissurotomy, balloon dilatation of aortic stenosis.