Edema are common during late pregnancy. They usually occur in the lower extremities, but occasionally they appear as swelling or swelling of the face or hands. Most etiology edema in pregnancy are Physiological edema Physiological edema are the consequence of hormone-induced sodium retention. Edema can arise when the enlarged uterus intermittently compressed inferior vena cava and thereby moves the venous return flow from the two femoral veins in the Lying. Pathological causes of edema are less frequent, but often dangerous. These include deep vein thrombosis (DVT) and preeclampsia (see Table: Causes of edema of the lower extremities in late pregnancy). DVT occurs more frequently during pregnancy because the pregnancy is a state of heightened blood coagulability and pregnant women are likely to move lower. Pre-eclampsia is caused by pregnancy-induced hypertension; However, not all women develop preeclampsia with edema. Extensive cellulitis that usually causes focal erythema may be similar general edema. Causes of edema of the lower extremities in late pregnancy cause suspected findings Diagnostic procedure Physiological edema symmetrical, bilateral edema in the leg, the mend lying diagnosis of exclusion TVT Painful unilateral swelling of a leg or leg, redness and warmth Occasionally, the presence of risk factors for TVT duplex sonography of the lower limbs Preeclampsia hypertension and proteinuria with or without significant independent edema (eg. As the face or hands), which, if present, not red, overheated or painful existence are sometimes of risk factors for pre-eclampsia in severe preeclampsia possibly also headache, pain in the right upper quadrant and / or upper abdomen and vision problems if necessary Papilledema, visual field deficits, and pulmonary rales (in addition to edema), while the physical examination determined blood pressure measurement of protein in urine blood count, electrolytes, blood urea nitrogen, glucose, creatinine, liver function tests cellulitis Schwerzhafte unilateral swelling on a leg or leg, redness ( asymmetrically), warmth, and occasionally fever manifestations often circumscribed than in TVT sonography to exclude DVT except swelling is highly localized investigation on the source of infection DVT = deep vein thrombosis. Clarification Diagnostics aims at the exclusion of DVT and preeclampsia. Physiological edema is a diagnosis of exclusion. History to history of the current disease should start and duration of the symptoms, inducing and soothing factors (a physiological edema relieved by lying in the left lateral position) and risk factors for DVT and preeclampsia include. Risk factors for DVT include venous insufficiency injuries Hyperkoagulabilitätsstörung Thrombotic diseases cigarette smoking immobility Malignant tumors of the risk factors for preeclampsia include chronic hypertension preeclampsia in their own or family history age <17 or> 35 years of First pregnancy multiple pregnancy diabetes vascular Hydatidiform Abnormal findings of the investigation maternal serum in reviewing the Organysteme attention is paid to symptoms of possible causes, including nausea and vomiting, abdominal pain and jaundice (preeclampsia), pain, redness or warmth on an extremity (DVT or cellulitis), dyspnea (Lu ngenödem or preeclampsia), sudden weight gain or edema of hands and face (preeclampsia) and headache, confusion, mental status changes, visual disturbances or seizures (eclampsia). The history should previous DVT, pulmonary embolism, preeclampsia and hypertension berücksichtigen.Körperliche investigation The investigation begins with review of vital signs, especially blood pressure. The regions with the edema to be examined and the presence of redness, warmth and pain sensitivity (on both sides and symmetrically on one side or d. E.) With respect to distribution. The general examination focuses on areas that may have findings of preeclampsia. The eye exam covers the exam of the visual field deficits, and using a fundus photography is examined for papilledema. The cardiovascular examination including auscultation of the heart and lungs for signs of fluid overload (z. B. audible S3 or S4 heart sounds, tachypnea, rales, crackling) and inspection of the jugular veins on jugular venous extension. The abdomen should be scanned for pain sensitivity, especially in the stomach area or right upper quadrant. During the neurological examination of the mental state assessed in terms of confusion and attention to focal neurological deficits should werden.Warnzeichen The following findings are particularly important: blood pressure ? 140/90 mmHg Unilateral warmth, redness or tenderness in the leg or in the calf with or without fever hypertension and any systemic symptoms or complaints, especially mental status changes interpretation of the findings Although edema is common during pregnancy, the consideration and the exclusion of the most dangerous causes (pre-eclampsia and TVT) is important, and a blood pressure> 140/90 mmHg should be thought of preeclampsia. If an edema in one leg only, especially if redness, warmth and sensitivity are present, TVT and cellulitis should be considered. Bilateral leg edema is an indication of a physiological process or preeclampsia as a cause. Clinical findings help in finding the cause (see Table: Causes of edema of the lower extremities in late pregnancy). Other findings may point to preeclampsia (see Table: indicative On preeclampsia findings). suggestive of preeclampsia findings organ system or body part Symptom Clinical Findings eye visual acuity visual field deficits, papilledema Cardiovascular dyspnea Reinforced S3 or S4 heart sound audible tachypnea, rales, crackling Gastrointestinal nausea, vomiting, jaundice Sensitive ness in the upper abdomen or upper right quadrant genitourinary Reduced urine output Oliguria Neurologically confusion, headache Abnormal mental status extremities weight gain, and suddenly inserting extremely edema of the legs, face and hands rash petechiae, purpura Tests Suspicion of preeclampsia, the proteins are determined in the urine; Hypertension plus proteinuria are indications of preeclampsia. In the routine, a urine strip test is used; But if the diagnosis is unclear, the determination of the protein in 24-h urine is useful. Many labs can quickly assess the protein in which they measure the ratio of protein in the urine creatinine in urine and calculate. If DVT is suspected, a duplex ultrasound of the lower extremity is performed. Treatment Specific causes are treated. Physiological edema can be (is moved away from the inferior vena cava whereby the uterus), reduced by intermittently higher exposure of the lower extremities and by the wearing of elastic compression stockings by intermittently Resting in the left lateral position. Summary edema are common and usually benign (physiologically) in late pregnancy. Physiological edema can be reduced by intermittently rest in the left lateral position, higher exposure of the lower limbs and compression stockings. Hypertension and proteinuria give pre-eclampsia can be seen. Unilateral redness, warmth and tenderness of a leg require clarification on a DVT.