Swollen Feet During Pregnancy

Swelling of the legs is a problem with which many pregnant women are familiar. Swollen feet are especially common in the second half of pregnancy, closer to the third trimester. This phenomenon gives future mothers a lot of unpleasant moments – her legs hurt, there is a feeling of heaviness, it becomes difficult to stand for a long time.

Why are the feet swollen during pregnancy?

During pregnancy, a woman’s body increases the volume of blood as well as intercellular fluid to meet the needs of the forming fetus. This process sometimes contributes to swelling of the lower extremities in pregnant women.

Swelling of the legs during pregnancy can be identified by the following signs:

• it is visible to the naked eye – the feet swell up, there are difficulties in wearing familiar shoes;
• The skin gets a pale shade and a “glossy” surface.

There are a number of reasons why women’s feet swell during pregnancy:

• Retention of a large volume of fluid in the body;
• the uterus, increasing in volume, puts pressure on the pelvic circulatory system, which prevents normal blood circulation;
• Hormonal changes that occur in a woman’s body during childbirth;
• Development of varicose veins.

Increased swelling of the lower extremities in women during pregnancy is quite common, but sometimes it is a consequence of a serious illness. It is necessary to seek help from a doctor if:

• Edema accompanied by pain is observed on only one leg. This may indicate the development of a thrombosis, which is a health hazard. Therefore, an urgent medical examination and subsequent treatment is required in this situation.
• Pain in the chest area or difficulty breathing. This may indicate the development of heart and vascular disease.
• Swelling of the legs appeared suddenly, which may indicate the development of late toxemia.

Self-diagnosis of the appearance of swelling can be made by pressing a finger on the skin of the front of the shin. The formation of a dimple that does not go away within a minute indicates the presence of edema. Swelling of the foot can be checked by pressing on the back or side of the foot. Also, if there is swelling, shoes and socks will leave marks, and previously comfortable shoes will become tight.

Why swelling during pregnancy

Physiological reasons

Causes of this manifestation in pregnancy are:

• overexertion;
• High ambient temperature, stuffiness, high humidity;
• Wearing high-heeled shoes;
• Prolonged walking, prolonged stay in a stationary position;
• Consumption of large quantities of salt or fluids.
• Patients of small stature are prone to the development of edema. A predisposing factor is overweight. In girls with a slight excess weight pastosity appears more often, but does not reach a high degree of severity. In patients with severe obesity the tendency to peripheral edema increases, the symptom becomes constant and is combined with shortness of breath, pain in the spine, leg joints.

Gestosis

Edema is characteristic of all late toxicosis, which, in fact, are successive stages of the same pathological process. The change of stages can be both gradual and lightning, which makes it important to consider the severity of the symptom and other manifestations to determine the severity of the condition and the need for emergency measures. The following variants of gestosis are possible:

• Hydration of pregnant women. Develops because of violations of the water-electrolyte balance, increased vascular permeability, the release of fluid into the tissues. At first, edema is insignificant, covering only the limbs, then the edema becomes generalized. A characteristic external sign is a glossy shade of the skin. The patient is disturbed by thirst. Decreased frequency of urination is marked.
• Nephropathy. Substitutes for dropsy in 25% of women. It is manifested by edema, proteinuria, and an increase in BP. Edema ranges from mild pastosity of the face and hands to generalized edema. Progressive hypertension is accompanied by headaches, nausea, vomiting. Other typical symptoms of nephropathy are weakness, dizziness, thirst, shortness of breath, dyspepsia, and low back pain.
• Preeclampsia. Forms after nephropathy. Swelling persists. The above signs are supplemented by heaviness in the back of the head, intense cephalgia, fatigue, lethargy, lethargy, tremor, sweaty hands, insomnia or increased somnolence. A quarter of patients have visual disturbances. Subscapular pain, nausea, vomiting are possible.
• Eclampsia. Replaces pre-eclampsia over a period not exceeding 3-4 days. On the background of swelling of the trunk and extremities, other symptoms of pre-eclampsia, there is a seizure, followed by a coma, which is transformed into recovery of consciousness or aggravated.

Inferior vena cava syndrome

Usually diagnosed after 25 weeks of pregnancy. It is manifested by tachycardia, weakness, difficulty in breathing, increased fetal movement in the supine position. Cardialgia, fear, anxiety, visual disturbances, tinnitus and ringing in the ears occur. Postural hypotension develops, and sometimes fainting occurs. Edemas in NPV syndrome are manifested in the lower extremities and are caused by worsening of blood outflow against compression of a large venous trunk.

Renal pathologies

An increased probability of edema during pregnancy is noted in women with a single kidney due to agenesis of the organ or after nephrectomy. Increased pressure on the urinary system can lead to morning swelling of the face, decrease or increase urine output, blood admixture, turbidity of the urine. The general condition worsens, with drowsiness, weakness, fatigue. There is a high probability of developing gestational pyelonephritis, which is manifested by dysuria, severe pain similar to renal colic.

Glomerulonephritis occurs against a background of infections, toxic influences, systemic pathologies. In the acute form of the disease, the face and eyelids suddenly become swollen, weakness, hyperthermia, chills, appetite disorders, pain in the lower back are observed. Urinary excretion decreases, and the urine becomes brown, red or pink in color.

More than half of patients with glomerulonephritis during pregnancy have a chronic course. Edematous syndrome is pronounced in 5% of patients. It may involve the face, hands, feet. In a severe course edema spreads to the whole body, anasarca develops. The presence of ascites is evidenced by a rapid increase in the abdomen. Increasing shortness of breath is a sign of hydrothorax.

Varicose veins

In 60-80% of cases, varicose veins are provoked by pregnancy; in the remaining women, they are aggravated by increased stress on the blood vessels. As a rule, it affects the lower extremities. At the initial stage, slight pastosity occurs in the evening, especially after prolonged standing, it is combined with a feeling of heaviness and “buzzing” in the legs. At a later stage, pains and local cramps occur. A pronounced edema of feet, ankles, lower parts of the lower legs proves that the deep veins are affected.

A rare variant of the disease is genital varicosity. There can be swelling of the labia and crotch, bleeding after sexual intercourse, itching, heaviness, and distension in the genital area. There are aching and dragging pains in the abdomen and genitals, radiating to the groin, sacrum, lower back.

Thrombophilia

This pathological condition is caused by a disorder of the blood coagulation system and is accompanied by the formation of blood clots. The most widespread complication of thrombophilia in pregnancy is thrombophlebitis. Leg edema in deep venous thrombosis is combined with extensional pain, lividity of skin, swelling of superficial veins, increase in local temperature, thickening, painfulness of damaged vessel. Due to placental vascular thrombosis, severe gestosis develops with massive edema of the abdomen, upper and lower extremities.

Arterial hypertension

In two-thirds of women provoked by pregnancy, after the birth of the child, the blood pressure normalizes. An increased tendency to edema of the distal parts of the legs is observed. Swelling of the hands is possible. The main manifestations of hypertension in pregnancy are dizziness, tinnitus, headaches, increased fatigue, shortness of breath, tachycardia.

Heart disease

The main cardiological cause of edema during pregnancy is considered to be insufficiency of circulation in rheumatic or congenital heart disease. Edema is mainly in the lower extremities: the legs, feet, ankles. Drowsiness, muscle weakness, fatigue, heart palpitations, shortness of breath, and bluish or pale skin are observed. A rarer cardiac pathology provoking the development of edema is dilated cardiomyopathy.

Thyroid abnormalities

Sufficiently common in pregnant women, iodine deficiency becomes the cause of edema only if the thyroid hormone level is reduced. In severe cases, clinically pronounced hypothyroidism develops. The most prominent edemas are observed on the face and neck, sometimes covering the entire body. The face is mask-like, puffy. There are no changes in skin color or impressions on pressure. Rapid weight gain, apathy, constipation, nausea, deterioration of hair and nails are found.

Hypovitaminosis

Swelling, seizures, lethargy, early toxicosis are observed in pregnant women with hypovitaminosis B6. The above symptoms are exacerbated by concomitant deficiency of vitamins B9 and B12. The development of a specific clinical picture is preceded by apathy, weakness, drowsiness, decreased appetite, impaired concentration, a tendency to colds.

Hidden edema in pregnancy

Besides obvious edema of the face, hands and feet, pregnant women may develop hidden edema of internal organs. They are dangerous for the baby as they interfere with the normal supply of oxygen and nutrients to the placenta.

Retention of fluid in the body may be a symptom of diseases of the urinary tract, endocrine or cardiovascular system. It may also indicate gestosis – late toxemia of pregnant women, which threatens the life of the mother and child.

To prevent this condition, doctors closely monitor the pregnant woman’s condition. During each visit to the antenatal clinic, they conduct weighing, measuring blood pressure and checking urine tests. A weight gain of more than 1 kg per week indicates fluid retention in the body. When combined with the appearance of protein in the urine and high blood pressure, it indicates gestosis. In this case the doctor recommends hospitalization.

Pathological conditions

Physiological swelling occurs in every pregnant woman and causes her no discomfort other than dissatisfaction with her appearance. You have to take off your rings and not wear them until you give birth. Shoes become small, some women buy boots and shoes a size larger. This is a normal condition, all excess water is eliminated from the body on its own within a week after delivery.

Gestosis is considered to be pathological. Its first symptom is severe swelling of the feet, an increase in leg volume of more than 0.4 in (1 cm) per week.

Other symptoms of gestosis are:

• Protein in the urine test;
• Vomiting or nausea;
• high blood pressure;
• headaches;
• cramps.

There are several stages of gestosis, with regular visits to the antenatal clinic doctors diagnose it at an early stage and take action immediately. If you do not visit the doctor and do not comply with the recommendations on the prevention of gestosis, it can lead to a deterioration of the condition, the appearance of cramps and kidney failure.

That is why at the early stages of gestosis doctors recommend visiting an experienced obstetrician-gynecologist. There, measures are taken to remove excess water and stimulate the kidneys. If nothing helps, an emergency cesarean section is performed. The baby is then nursed in an incubator, and the woman’s body is helped to get her kidneys working again.

Diagnosis

The obstetrician-gynecologist determines the cause of the symptom in pregnancy. If indicated, the patient is referred for consultation to a nephrologist, phlebologist, cardiologist and other specialists. Examination is performed using the following techniques:

• Collection of anamnesis. The doctor interviews the patient, identifying clinical signs of swelling. Swelling of the feet is indicated by the feeling that the usual shoes have become tight, the inability to button the boots, pronounced, long-lasting traces of rubber bands of socks on the skin. Swelling of the hands is evidenced by problems in removing and putting on rings.
• Physical examination. The specialist determines the prevalence of edema, establishes manifestations that indicate the etiology of the symptom. Detects external and palpatory signs of ascites and anasarca, listens to the heart and lungs to detect malformations, hydrothorax.
• Special measurements. Indicated when hidden edema is suspected. Based on determining the daily weight gain, calculation of diuresis. Normal weekly increase in body weight is less than 300 g, daily volume of fluid drunk exceeds the amount of urine by no more than 20-25%. Deviation of these indices indicates a high probability of edema.
• Hardware methods. Safe, sufficiently informative ultrasound and electrophysiological studies are recommended. Conducted gynecological ultrasound, Doppler uteroplacental blood flow. When the urinary system abnormalities appointed ultrasound kidney with hypothyroidism – Ultrasound thyroid gland, with varicose veins and thrombophlebitis – Ultrasound lower limbs. For cardiological patients, along with echocardiography, ECG, diurnal, phonocardiography are performed.
• Laboratory tests. In kidney disease, general and biochemical urine tests are indicated, in hypothyroidism – hormone tests. To determine the presence and type of thrombophilia carried out special studies. Laboratory examination in gestosis includes OAC, OAM, biochemical blood and urine tests, coagulogram.

If you have excessive swelling of the feet during pregnancy, a complete diagnosis becomes necessary and should not be neglected.

What to do to reduce swelling of the legs during pregnancy?

Swelling of the legs and feet that appears in the second half of pregnancy usually disappears immediately after the birth of the child. However, until then, a lot of swelling gives a woman a lot of inconvenience and discomfort. To alleviate the overall feeling of well-being, the following recommendations should be followed:

• Reduce the level of load on the lower extremities, try not to be in an upright position for a long time. When resting, place your feet on a low stand.
• It is not recommended to lie on your back while sleeping – it is better to lie on your left side. This method will help to “unload” the pelvic veins, which are responsible for the movement of blood from the lower body to the heart.
• Getting ready to sleep, it is advisable to put a small cylinder or pillow under your feet, so that they are in a slightly elevated position.
• Cold packs can have a calming and restorative effect on swollen feet.
• A foot massage is a good way to relieve the swelling.
• In the last trimester of pregnancy you should not wear tight clothes, as well as tight shoes.

Help to reduce swelling of the feet feasible physical activity. To do this, you should:

• Carry out daily walks.
• If there are no contraindications, you can do on a stationary bike.
• Good help classes in the pool – the pressure of cool water on the swollen feet and legs has a refreshing and toning effect on the skin.
• Physical exercises performed in the water help to increase the number of heartbeats and, as a consequence, reduce swelling.
• It is recommended to do small exercises during the day: bend and unbend one and then the other leg, make circular movements of the foot to one side and then the other.

Regular exercise improves blood circulation, reduces the degree of swelling in the legs and feet and prevents cramps in the calf muscles.

Proper nutrition to reduce swelling

A correctly organized diet may not be able to prevent edema at all, but it may prevent it from getting worse. When feet swell too much, nutritionists recommend adhering to the following dietary principles:

• During each meal, consume small amounts of protein contained in dishes from meat, fish, eggs or legumes;
• Limit consumption of fatty, sweet and salty dishes, as this will help the kidneys to remove excess fluid from the body;
• Give up marinades and canned food that contain a lot of salt, because it helps to retain fluid in the body.
• It is important to drink enough water – nutritionists advise consuming at least 1.5 liters of clean water per day. Such advice may seem counterintuitive, but in fact such intake helps in getting rid of excess sodium, as well as other harmful substances, which as a result reduces swelling. The measure is not suitable for women with high blood pressure and kidney problems.
• Preference should be given to foods containing large amounts of vitamin C – these are bell peppers, onions, melons, tomatoes, strawberries, broccoli, lemon.
• It is necessary to take special vitamins prescribed by the attending physician, as well as strengthening agents.

In general, many moms already find that the swelling goes away in a day after the birth of the baby. But it is still necessary to use every opportunity to relieve your condition and take care of your feet at such an exciting and important time in your life.

When to see the doctor

The most frequent signs of edema are rings and straps on shoes that begin to press much and cause discomfort. In this case it is recommended to buy looser shoes, and not to wear rings until the end of the pregnancy. Slight swelling of the face, upper and lower eyelids usually appears in the morning hours and subsides on its own in the evening.

You should see a doctor in the following cases:

• if there is rapid weight gain, more than 1 lb (500 grams) per week;
• If the swelling does not go away during the day;
• numbness, tingling in swollen hands or feet;
• If fingers and toes are difficult or impossible to bend and feet are painful to step on;
• shortness of breath, or palpitations.

You can check for swelling by pressing the skin with your finger. If no trace remains, everything is normal. If a pale dimple remains that slowly evens out, you need to see a doctor.