Edema in a pregnant woman who does not have high blood pressure or protein in the urine is
As pregnancy progresses, fluid may accumulate in tissues, usually in the feet, ankles, and legs, causing them to swell and appear puffy. This condition is called edema. Occasionally, the face and hands also swell. Some fluid accumulation during pregnancy is normal, particularly during the 3rd trimester. It is called physiologic edema. Show Fluid accumulates during pregnancy because the adrenal glands produce more of the hormones that make the body retain fluids (aldosterone and cortisol). Fluid also accumulates because the enlarging uterus interferes with blood flow from the legs to the heart. As a result, fluid backs up in the veins of the legs and seeps out into the surrounding tissues. Usually during pregnancy, swelling is
In preeclampsia, blood pressure and protein levels in urine increase during pregnancy. Fluids may accumulate, causing swelling in the face, hands, or feet and weight gain. If severe, preeclampsia can damage organs, such as the brain, kidneys, lungs, or liver, and cause problems in the baby. Peripartum cardiomyopathy causes shortness of breath and fatigue as well as swelling. In cellulitis, bacteria infect the skin and tissues under the skin, sometimes causing swelling with redness and tenderness. Cellulitis most commonly affects the legs but may occur anywhere. The risk of deep vein thrombosis and preeclampsia is increased by various conditions (risk factors). For deep vein thrombosis, risk factors include the following:
For preeclampsia, risk factors include
For peripartum cardiomyopathy, risk factors include the following:
Doctors must rule out deep vein thrombosis, preeclampsia, a heart disorder, cellulitis, and other possible causes before they can diagnose physiologic edema. In pregnant women with swollen legs, the following symptoms are cause for concern:
Women should go to the hospital immediately if they have
Women with other warning signs should see a doctor that day. Women without warning signs should see a doctor, but a delay of several days is usually not harmful. Doctors ask the following:
Lying on the left side decreases physiologic edema. Doctors also ask about conditions that increase the risk of developing deep vein thrombosis, preeclampsia, and peripartum cardiomyopathy. Women are asked about other symptoms, which may suggest a cause. They are asked whether they have ever had deep vein thrombosis, pulmonary embolism, preeclampsia, high blood pressure, or heart problems, including cardiomyopathy. During the physical examination, doctors look for evidence of a serious cause. To check for symptoms of preeclampsia, doctors measure blood pressure, listen to the heart and lungs, and may check the woman's reflexes and look at the back of her eyes with an ophthalmoscope (a handheld device that resembles a small flashlight). Doctors also look for areas of swelling, particularly in the legs, hands, and face. Any swollen areas are checked to see if they are red, warm, or tender. If deep vein thrombosis is suspected, Doppler ultrasonography of the affected leg is done. This test can show disturbances in blood flow caused by blood clots in the leg veins. If preeclampsia is suspected, the protein level is measured in a urine sample. High blood pressure plus a high protein level in urine indicates preeclampsia. If the diagnosis is unclear, the woman is asked to collect her urine for 24 hours, and protein is measured in that volume of urine. This measurement is more accurate. However, preeclampsia may also be present if the protein level in urine is normal. High blood pressure with headache, changes in vision, abdominal pain, or abnormal blood or urine test results may also indicate preeclampsia. If peripartum cardiomyopathy is suspected, electrocardiography, chest x-ray, echocardiography, and blood tests to check heart function are done. When swelling results from a disorder, that disorder is treated. The swelling that occurs normally during pregnancy can be reduced by doing the following:
Can you have preeclampsia without high blood pressure and protein in urine?Women with preeclampsia develop high blood pressure (defined as a sustained elevation greater than 140/90 mmHg) and generally have protein in their urine, although some women develop other features of the disease without proteinuria.
Can you have preeclampsia without protein in urine?According to guidelines released by the American College of Obstetricians and Gynecologists, the diagnosis of preeclampsia no longer requires the detection of high levels of protein in the urine (proteinuria).
Can you have preeclampsia without high blood pressure?Recent data suggest that in some women, preeclampsia and even eclampsia may develop in the absence of hypertension or proteinuria.
Does everyone with preeclampsia have protein in urine?People with preeclampsia often have high blood pressure (hypertension) and high levels of protein in their urine (proteinuria). Preeclampsia typically develops after the 20th week of pregnancy. It can also affect other organs in the body and be dangerous for both the mom and her developing fetus (unborn baby).
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