31-year-old G3P2L2 presents at 34 weeks with baseline blood pressures 100-110/ 60-70. She has bilateral pedal edema. Her urine indicates trace protein & BP today is 115/75. On physical exam, there is pitting edema of both legs without any calf tenderness. Whats the best management now?
During pregnancy, there is a decrease in colloid osmotic pressure and a fall in plasma osmolality. There is an increase in venous pressure created by paial occlusion of the vena cava by the gravid uterus, which also contributes to pedal edema. Salt restriction won't help in the physiological edema Doppler studies of the lower extremities are not indicated in this patient since the history and examination, the lack of calf tenderness etc are all consistent with physiologic edema.
Frusemide to reduce the swelling
Do urgent venous Doppler studies done to rule out deep vein thromboses
Admit the patient & rule out preeclampsia
This is a normal finding of pregnancy, and no treatment is needed
Physiological Changes of Pregnancy