A healthy 31-year-old G3P2002 patient presents to the obstetrician's office at 34 weeks gestational age for a routine return visit. She has had an uneventful pregnancy to date. Her baseline blood pressures were 100-110/ 60-70, and she has gained a total of 20 lb so far. During the visit, the patient complains of bilateral pedal edema that sometimes causes her feet to ache at the end of the day. Her urine dip indicates trace protein, and her blood pressure in the office is currently 115/75. She denies any other symptoms or complaints. On physical exam, there is pitting edema of both legs without any calf tenderness. How should the obstetrician respond to the patient's concern?
Increased fluid retention manifested by pitting edema of the ankles and legs is a normal finding in pregnancy. During pregnancy, there is a decrease in colloid osmotic pressure and a fall in plasma osmolality. Moreover, there is an increase in venous pressure created by partial occlusion of the vena cava by the gravid uterus, which also contributes to pedal edema. Diuretics are sometimes given to pregnant women who have chronic hypertension, but this is not the case in this patient. More commonly, Lasix is used in the acute setting to treat pulmonary edema. This patient is not hypertensive and does not have any other signs or symptoms of preeclampsia and therefore does not need to be admitted for a further workup. Trace protein in the urine is common in normal pregnancies and is not of concern. Doppler studies of the lower extremities are not indicated in this patient since the history and exam (specifically, the lack of calf tenderness) are consistent with physiologic edema. The normal swelling detected in pregnancy is not prevented by a low-sodium diet or improved with a lower intake of salt.
Prescribe Lasix to relieve the painful swelling
Immediately send the patient to the radiology department to have venous Doppler studies done to rule out deep vein thromboses
Admit the patient to L and D to rule out preeclampsia
Reassure the patient that this is a normal finding of pregnancy, and no treatment is needed
Antepartum Haemorrhage