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This question was answered on Sun 06, Apr 2008 09:37am by Dr Bobby V, MD

Pregnancy question about swelling - Swelling in ankles, hands and may be face



    
Asked by Unregistered ; 44 ) on Sun 06, Apr 2008 01:59am

I am 34 yrs old and 36 weeks pregnant. I have been having swelling in my ankles in the evenings when I come home from work, and my hands and possibly my face ( at least it looks swollen) in the mornings. All the swelling goes away.But a day and a half ago my ankles, feet, calfs of my legs and knees where very swollen when I came home from work, the sweeling went down slightly on my knees, but rest of the swelling has not gone, is this normal ? This is my 4th pregnancy, my last one was 9 yrs ago, I never have had any swelling ever before.

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Answer by Dr Bobby V, MD (doctor) on Sun 06, Apr 2008 09:37am:

Hi amyjo, Congratulations on your fourth pregnancy! You are concerned about the swelling of your lower limbs and the face during the last trimester of your pregnancy, especially since you never had similar symptoms during your earlier pregnancies. There are two possibilities that we need to consider in your case: either it is a normal finding, or it is a sign of pre-eclampsia. Swelling of the feet during the last trimester of pregnancy is a common occurrence. The normal physiology is such that women tend to retain more water during pregnancy. Also, swelling of feet increases as pregnancy advances because of the compression of the large veins in the pelvis caused by the enlarged uterus. There is no effective therapy for this, except to wait for the baby to be delivered. In most cases, the swelling of the feet resolve rapidly after delivery. The other possibility that we need to rule out is a condition called “pre-eclampsia”. It refers to a constellation of findings including hypertension, swelling of feet, hands, and face, and the presence of increased amount of protein in the urine. The treatment of this condition involves the delivery of the baby and the placenta. Should you be alarmed? No. You need not be alarmed at your feet being swollen. As there is no other evidence of any other symptoms (you have not described any changes in urinary habits, for instance, nor mentioned that your blood pressure was found elevated), you need not be worried. The fact that you have not had pre-eclampsia during your previous three pregnancies is also comforting. Should you see a doctor? Yes, and soon. You must see your doctor, and get your blood pressure recorded at least twice, about half an hour apart. You should request him/her to get your urine tested for proteins. This will help rule out pre-eclampsia. Can this be serious? Pre-eclampsia can be managed effectively by modern medical care, with a good outcome in a vast majority of cases. Since you are 36 weeks into this pregnancy already, a happy outcome is likely. In the meanwhile, you can try to adopt a more effective posture while lying down. Since the veins of the legs ultimately drain into the inferior vena cava that is located on the right side adjacent to the spinal cord, it will help if you could lie down on your left side to relieve pressure on it and facilitate better venous drainage. I wish you and your baby all the best! Further reading: http://en.wikipedia.org/wiki/Pre-eclampsia http://www.babycenter.com/0_swollen-extremities-edema-during-pregnancy_230.bc#articlesection1

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