Late pregnancy swelling

Swollen ankles, feet and fingers in pregnancy

It's normal to get some swelling in pregnancy, particularly in your legs, ankles, feet and fingers.

It's often worse at the end of the day and further into your pregnancy.

Swelling that comes on gradually is not usually harmful to you or your baby, but it can be uncomfortable.

A sudden increase in swelling can be a sign of pre-eclampsia, a condition that needs to be monitored as soon as possible.

Non-urgent advice: Call your midwife, GP or labour ward immediately if you have:

• a sudden increase in swelling in your face, hands or feet
• a very bad headache
• problems with your vision, such as blurring or flashing lights in your eyes
• severe pain just below your ribs
• vomiting with any of these symptoms

These could be symptoms of pre-eclampsia, which can lead to serious complications if it's not monitored and treated.

Normal pregnancy swelling

Swelling is caused by your body holding more water than usual when you're pregnant.

Throughout the day the extra water tends to gather in the lowest parts of the body, especially if the weather is hot or you have been standing a lot.

The pressure of your growing womb can also affect the blood flow in your legs. This can cause fluid to build up in your legs, ankles and feet.

What can help to reduce swelling

Try to:

• avoid standing for long periods
• wear comfortable shoes and socks – avoid tight straps or anything that might pinch if your feet swell
• try to rest with your feet up as much as you can
• drink plenty of water – this helps your body get rid of excess water
• exercise – try to take regular walks during the day or doing foot exercises

Foot exercises

You can do foot exercises sitting or standing. They improve blood circulation, reduce swelling in the ankles, and prevent cramp in the calf muscles:

• bend and stretch your foot up and down 30 times
• rotate each foot in a circle 8 times one way and 8 times the other way

Get more tips on exercising in pregnancy.

Page last reviewed: 10 March 2021
Next review due: 10 March 2024

Swelling during pregnancy | Pregnancy Birth and Baby

3-minute read

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Most women get swollen ankles and feet while pregnant. It’s natural to have concerns about swelling since it can be uncomfortable, make your shoes tighter and possibly make you feel embarrassed. Knowing what to look for and how best to manage it can help you stay as comfortable as possible.

Why do women experience swelling during pregnancy?

There are 3 main reasons women experience swelling while pregnant.

• Throughout pregnancy, you produce more blood than usual to help your baby grow.
• As the baby grows, your uterus presses on and slightly blocks the veins that return blood from your legs to your heart.
• Your hormones make the walls of your veins softer, which makes it harder for them to work properly.

For these reasons, your blood tends to pool in your legs. There, a small amount of blood leaks through tiny blood vessels into the tissues and produces the swelling you can see and feel.

Where and when will I get swelling?

The swelling should be only in your feet and ankles. Your fingers might get a little larger — enough to make any rings feel tight — but they shouldn't be obviously swollen.

Your feet and ankles are likely to swell later in the day. This is mainly due to gravity — any extra fluid in your body will sink to your feet and ankles, especially if you spend a lot of time on your feet.

Swelling is also more likely to happen later in your pregnancy.

Gradual swelling isn't harmful to you or your baby, but it can feel uncomfortable.

How can I reduce swelling?

Some simple things can help you feel more comfortable and can also aid in preventing swelling.

Try to:

• avoid standing for long periods without moving
• wear comfortable shoes (avoid tight straps or anything that might pinch if your feet swell)
• put your feet up as much as you can
• limit salty foods and excessive salt in your diet
• sleep on your left side, which will help blood return to the heart
• exercise regularly by walking or swimming — this helps keep your circulation going

If you need to stand for long periods, try to move around and change position regularly.

Compression stockings can help the blood flow back to the heart and limit how much swelling you get. Massage and reflexology might also help reduce swelling and associated symptoms.

Even if your swelling is bothering you, remember to still drink plenty of water. Keeping your fluids up is important to avoid dehydration and stay healthy.

Normal or abnormal swelling?

Most pregnant women have swollen feet and ankles at some point, and this is perfectly normal. However, there are times when swelling could indicate something more serious.

Contact your midwife, doctor or hospital immediately if:

• swelling is there at the start of the day or doesn't go down when you rest
• your face or hands are swollen
• the swelling is more than you have had before

These are warning signs for pre-eclampsia, which is high blood pressure caused by pregnancy. This is a very serious condition both for you and your baby, so call your doctor or midwife as soon as possible. Don't wait for your next regular appointment.

If one leg is more swollen than the other, this could suggest a more serious problem with one of your veins, such as deep vein thrombosis. Again, contact your doctor or midwife as soon as possible.

Most swelling is a normal part of pregnancy and will usually go away after you've given birth. However, if you're concerned about anything, no matter how small or seemingly insignificant, talk to your doctor or midwife.

You can also call Pregnancy, Birth and Baby on 1800 882 436 to talk to a maternal child health nurse.

Sources:

Learn more here about the development and quality assurance of healthdirect content.

Last reviewed: February 2020

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Related pages

• Common discomforts during pregnancy
• Varicose veins
• Leg cramps during pregnancy

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Colorectal cancer in pregnant women

Oncological diseases are observed in 1 out of 1000 pregnant women [1-3]. The most common such diseases are female genital cancer or breast cancer, melanoma, lymphoma and leukemia. Colorectal cancer (CRC) occurs in 1 in 50,000 pregnant women [1]. There are few data on the combination of CRC and pregnancy in the literature, and there are no specific clinical recommendations. The practical doctor, who faces the task of treating such a patient, often finds himself in a difficult position. We present our own clinical observations. nine0003

Patient B., , 38 years old, was admitted to Lapino Clinical Hospital on March 2, 2014 with a diagnosis of pregnancy 23—24 weeks, rectal cancer, cT3NxMx. From the anamnesis it is known that the real pregnancy is the second, the first 12 years ago ended in a timely manner with an operative delivery without complications. Heredity is not burdened, does not suffer from chronic diseases. During pregnancy, the patient noted periodic constipation and small bloody discharge from the rectum during defecation. A sigmoidoscopy was performed at the place of residence, which revealed a tumor of the rectum at a distance of 15-18 cm from the anus. Histological examination of the biopsy revealed a highly differentiated adenocarcinoma. nine0003

Examined at Lapino Clinical Hospital. Pregnancy proceeds without features, corresponds to a period of 24 weeks. Pathological changes in the fetus were not detected. A colonoscopy was performed: when examining 70 cm of the large intestine, no additional formations were found in the intestine. Ultrasound of the uterus revealed a scar and two myomatous nodes measuring 39×22 and 23×16 mm, head presentation of the fetus. An MRI scan diagnosed a tumor of the rectum without signs of invasion into the surrounding structures, no secondary foci were detected. According to laboratory tests, no significant deviations from the norm were revealed. The level of cancer-embryonic antigen is increased to 21 ng/ml. The diagnosis was made: pregnancy 23-24 weeks, highly differentiated adenocarcinoma of the rectum, cT3NxM0. nine0003

The situation was discussed with the patient and her relatives, the nature of the disease and possible complications were explained. The patient expressed a strong desire to continue the pregnancy. A consultation was held consisting of an obstetrician-gynecologist, a surgeon, an oncologist and an anesthesiologist. It was decided to perform surgery in the volume of anterior resection of the rectum with the formation of a colorectal anastomosis and preservation of pregnancy.

06.03.14 the patient was operated on. An upper median laparotomy was performed due to the large size of the uterus. The uterus was removed from the abdominal cavity. Examination of the abdominal cavity revealed no distant metastases. An exophytic circular tumor with a diameter of 6 cm is detected in the distal third of the sigmoid colon and the rectosigmoid region. There is no invasion of the tumor into the surrounding anatomical structures. An extrafascial anterior resection of the rectum was performed with the formation of a colorectal anastomosis with a stapler. Then bilateral wedge resection of the ovaries was performed. An urgent histological examination did not reveal any atypical cells in the resected ovarian tissue. It was decided to refrain from performing bilateral salpingo-oophrectomy. The laparotomic wound was sutured in layers. nine0003

Histological examination of the resected rectum revealed a moderately differentiated ulcerated adenocarcinoma, growing in one of the areas into the mesorectal tissue. There is abscessing of the intestinal wall in the area of ​​tumor growth. No tumor growth was detected in the resection margins. 2 out of 15 lymph nodes have adenocarcinoma metastases. Thus, the stage of the tumor process is defined as IIIB, according to the TNM classification - as pT3pN1cM0.

The postoperative period was uneventful. The patient became active on the 2nd day. On the 3rd day there was an independent chair. Due to the increased tone of the uterus, she received Hemipral for 3 days. She was discharged in a satisfactory condition on the 8th day. In the future, the pregnancy proceeded without complications, ended in operative delivery at the 38th week. A healthy girl was born weighing 2750 g, height 49cm, 8 points on the Apgar scale. The patient was examined one month after delivery: colonoscopy and ultrasound of the abdominal cavity were performed. There were no signs of recurrence of the disease.

Patient K., , 37 years old, was hospitalized at the Institute of Surgery named after A.V. Vishnevsky on 02.07.14 with a diagnosis of sigmoid colon cancer, cT3NxM0. Heredity is not burdened, does not suffer from chronic diseases. From the anamnesis it is known that on March 10, 2014, her pregnancy ended in operative delivery without complications. This pregnancy is the second, the first 8 years ago ended in a timely manner with childbirth without complications. nine0003

Starting from the first trimester of the last pregnancy, the patient noted constipation and the discharge of unchanged blood from the rectum during defecation, however, the obstetricians-gynecologists who observed her associated this with "hemorrhoids aggravated during pregnancy." After childbirth, these symptoms persisted, which was the reason for contacting a surgeon. An examination has been carried out. A colonoscopy was performed: at a distance of 25 cm from the anus, a loose polypoid formation up to 4 cm in diameter was detected, a biopsy material was taken. Histological examination of the biopsy showed a picture of highly differentiated adenocarcinoma. Computed tomography of the thoracic and abdominal organs with intravenous contrast was performed, a tumor of the sigmoid colon 7.2 cm in diameter was diagnosed, regional lymphadenopathy, no secondary foci were detected. nine0003

04.07 the patient was operated on. A laparoscopic left-sided hemicolectomy was performed with the formation of a transverse rectoanastomosis with a device for applying a mechanical suture. Intraoperatively during the revision of the abdominal cavity, no distant metastases were detected. Macropreparation: circular saucer-shaped tumor 6 cm long. After cutting the tumor, it is seen that it grows into all layers of the intestinal wall and grows into the surrounding tissue in the form of a node with a diameter of 2 cm.

Histological examination shows a moderately differentiated adenocarcinoma of the sigmoid colon, invading all layers of the intestinal wall and growing into the mesenteric tissue. Tumor with minor perifocal inflammation, foci of perineural invasion. In 7 out of 27 lymph nodes examined, tumor metastases of a similar structure were found. Thus, the stage of the tumor process is defined as IIIc, according to the TNM classification - as pT3pN2bcM0.

The postoperative period was uneventful. On the 2nd day there was an independent chair. She was discharged in a satisfactory condition on the 6th day after the operation. She was referred for adjuvant chemotherapy. At the control examination after 1 month, the patient's condition is satisfactory, the abdomen is soft, painless, physiological functions are not disturbed. The patient is under the supervision of an oncologist at the place of residence, adjuvant chemotherapy is being carried out according to the FOLFOX scheme. nine0003

CRC in combination with pregnancy is a major clinical problem. At a young age, CRC is rare and, as a rule, in patients with a genetic predisposition. However, hereditary forms of cancer, as well as chronic inflammatory bowel disease, are rare in pregnant women with CRC. So, in the study by R. Girard et al. [9], only 4 out of 19 patients had these factors. There have been suggestions about the role of hormones in the occurrence of tumors, the level of which increases during pregnancy. However, in the study by M. Slattery et al. [15], only 1 out of 156 samples of colorectal malignant tumors in pregnant women turned out to be positive for estrogen receptors, and none of them showed positive receptors for progesterone. Single reports have been published on the role of insulin-like growth factor I (IGF I), placental growth factor and pro-angiogenic factors, the level of which increases during pregnancy [10]. Thus, to date, the genesis of CRC in pregnant women has been little studied, and the results of studies conducted in this area raise more questions than they answer. nine0003

Symptoms of CRC in pregnant women do not differ from the classic symptom complex - abdominal pain, anemia, constipation, rectal bleeding. These manifestations can also occur during normal pregnancy, which leads to late diagnosis [14]. So, in the largest study by M. Bernstein et al. [2], which included 39 patients, according to the Dukes classification, there was no stage A in any observation, stage B was noted in 41%, stage C in 44%, and stage D in 15% of patients.

Instrumental diagnosis of CRC in pregnant women has a number of features. Performing sigmoidoscopy and partial colonoscopy of the left colon in pregnant women is safe [4]. If it is necessary to examine the right sections of the colon, the procedure should be performed with caution, since the development of inferior vena cava compression syndrome is possible [3]. nine0003

Computed tomography is contraindicated due to the risk of radiation damage to the fetus. The methods of choice are magnetic resonance imaging (MRI) and ultrasound.

Clinical and epidemiological signs of CRC in pregnant women and in the general population are presented in the table.

Clinical and epidemiological signs of colorectal cancer in pregnant women and in the general population

The choice of tactics for the treatment of CRC in combination with pregnancy depends on the stage of the disease and on the gestational age. nine0003

When diagnosing CRC during the first half of pregnancy, most sources of literature at the early stages recommend surgery with preservation of pregnancy, in the presence of signs of tumor invasion into neighboring structures or in the presence of distant metastases, termination of pregnancy with subsequent complex treatment. Surgical intervention with preservation of pregnancy in its first half is associated with the risk of fetal death in no more than 3.8% of cases [11]. When diagnosing a tumor in the second half of pregnancy, it is recommended to postpone the operation until the time of delivery, which should occur as early as possible. It is believed that a viable baby can be born after 32 weeks of gestation. The method of delivery does not matter; childbirth is possible both through the natural birth canal and by caesarean section. At the same time, CRC surgery can be combined with a caesarean section or postponed for 1-2 weeks in order to reduce the size of the uterus [13]. The latter is especially important in low rectal cancer. nine0003

Removal of a tumor with signs of invasion into neighboring structures should be carried out as a single block; if there are signs of tumor invasion into the uterus, hysterectomy is indicated [12].

Most authors recommend performing prophylactic salpingo-oophrectomy due to the high incidence of CRC metastasis in the ovaries in pregnant patients compared with non-pregnant patients (25-30% and 3-8%, respectively) [1, 12]. It is possible to perform a bilateral wedge-shaped resection of the ovaries with an urgent histological examination, based on the results of which a decision is made to remove them. If a decision is made to keep the pregnancy, bilateral salpingo-oophrectomy is not recommended due to the high risk of spontaneous abortion, but wedge resection with urgent histological examination is mandatory [12]. If atypical cells are detected in the resected ovarian tissue, the decision on further tactics should be taken collectively. In the presence of metastatic lesions of the ovaries, the life expectancy of patients is 3–12 months [12]. nine0003

Operation in the second half of pregnancy may be associated with severe technical difficulties due to an enlarged uterus, as well as a risk to the fetus with prolonged anesthesia and severe blood loss. In addition, the pressure of the uterus on the inferior vena cava during surgery can lead to the development of compression syndrome of the inferior vena cava. As a prevention of this complication, it is proposed in the literature to place the operating table with an inclination to the left [13].

The prognosis for CRC in combination with pregnancy depends on the stage of the disease. In a study by M. Dahling et al. [7], who included 134 pregnant women with CRC, showed no differences in survival rates in the group of patients and in the general population.

Thus, CRC in combination with pregnancy is rare and has certain differences from CRC in the general population. Late diagnosis is due to the fact that the existing symptoms are often not given due importance, this is a serious problem. All pregnant women who complain of rectal bleeding and constipation should be examined by a surgeon and examined with sigmoidoscopy. Currently, in such situations, there are no clear clinical recommendations, and the definition of treatment tactics should be done collegially with the participation of an obstetrician-gynecologist, oncologist, surgeon, anesthetist. The patient should be fully informed about the nature of her disease and possible complications, and her opinion should be decisive. Treatment of CRC in late pregnancy is usually delayed until the time of delivery, which is associated with the risk of developing locally advanced or generalized forms of the disease. The first case presented demonstrates the possibility of successfully performing radical surgery for rectal cancer in late pregnancy with its preservation. nine0003

Treatment of cancer in pregnant patients

REASONS

PAROKONNAYA Anastasia Anatolyevna

Doctor of Medical Sciences, Senior Researcher, Department of Radiosurgery, Research Institute of Clinical and Experimental Radiology, FBSI N.N. N.N. Blokhin” of the Ministry of Health of the Russian Federation

Pregnancy cancer

What types of cancer can occur during pregnancy?

In the first place today, we note the incidence of cervical cancer, melanoma and breast cancer in pregnant women. Further, we are already talking about lymphoproliferative diseases, such as Hodgkin's lymphoma, non-Hodgkin's lymphoma, various types of oncological pathology of the intestine. nine0003

But this is a very rare situation, so we still say, first of all, "cervical cancer", "melanoma", "breast cancer". In principle, today these types of cancer in pregnant women have already been learned to be treated quite effectively.

Can pregnancy provoke the development of oncology?

There is a misconception that pregnancy can cause some type of cancer. In fact, pregnancy can accelerate the development of an already existing disease, but it is impossible to provoke some kind of disease to growth. nine0003

Some people think, on the contrary, that pregnancy is such a wonderful condition in which cancer in general

cannot be diagnosed and cannot be established, because this is a sunny state when the whole body of a woman is set to positive, and any oncology is generally unthinkable during this period.

In fact, unfortunately, this is not entirely true. If a woman already had some kind of small tumor, even a few millimeters, then, unfortunately, in some cases, pregnancy can provoke its growth. nine0003

Can IVF cause cancer?

In recent years, we are increasingly talking and hearing that the IVF program and everything related to in vitro fertilization can cause cancer during pregnancy. In my opinion, this is not entirely true.

It is my deep conviction that the IVF program itself and hyperstimulation cannot lead a woman to cancer during pregnancy, because the mechanism is probably different. Probably, unfortunately, women come to the IVF program already having a certain development of the tumor. Let it be minimal, but there is simply no accurate diagnosis during the preparation for the program, firstly. nine0003

Unfortunately, there is no good consultation, for example, by the same mammologist before the IVF program or carrying out extensive diagnostic

measures that would help identify the tumor before starting this program. Therefore, this is how the deployment, the manifestation of the disease, occurs at the moment when in vitro fertilization is performed, and the woman has already, for example, become pregnant.

Therefore, we see and hear more and more about these cases, but in fact, it seems to me that this is not a very clear and precise diagnosis at the stage of preparation for this program. Therefore, it is very important for our fellow reproductive specialists to know and remember that in the modern world, with such a very important event as in vitro fertilization, we must do everything to exclude the possible oncological disease before the program. nine0003

How often can a pregnancy be maintained if cancer is detected?

Of course, at the first visit of a woman with cancer during pregnancy, we must: firstly, assess the stage of the disease. We have the ability to safely diagnose the fetus today. This is the first.
The second, of course, at what stage of pregnancy she came. If this is the second or third trimester of pregnancy, we can discuss with the woman the option, for example, of early delivery and the start of treatment after delivery. nine0115 But if a woman comes at the very beginning of her pregnancy, for example, in the first trimester, and she has the fourth stage of cancer, then, unfortunately, in these cases it is sometimes necessary to discuss the option of terminating the pregnancy with her, but this is extremely rare.

Again, I repeat that they come far from the first trimester, but usually come in the middle of the second trimester, when it is simply inhuman, in my opinion, to terminate a pregnancy at a period of 24-25 weeks, when the arms, legs, head are already formed - we already have everything. All that remains is to develop this fetus, this child. nine0003

Of course, if the stage is still quite common, and we are talking about saving, immediately saving the life of a woman, we have to discuss abortion with her, but, I say again, this is very rare today, because, again, I repeat: we have learned already treat such women at any time.

Symptoms and treatment features

What signs and symptoms of breast cancer should alert a pregnant woman?

Oncological disease, unfortunately, of course, depends on the phase or duration of pregnancy with which the patient applied, having this disease. If the patient comes in late pregnancy, and the tumor began to appear, appeared and began to develop somewhere at the beginning of this pregnancy, respectively, by the end of pregnancy, this tumor will reach a large size. This is the first moment. nine0003

The second thing that affects the development of the disease during pregnancy. Unfortunately, I am very sad to talk about this, but I am forced to say this. These are the mistakes of our doctors, who often take, for example, an inflammatory disease, the same mastitis, or some related problems associated with pregnancy, for an accompanying calm pathological process, of course, but not cancer.

The problem here is that these doctors consider it possible to try to treat such patients on their own, not to make a diagnosis in time, not to conduct the minimum oncological examination that we need in order to make a diagnosis on time. nine0003

Therefore, first of all, think about the fact that your life and the life of your unborn child are in your hands.
Maybe even apply without a referral, and then, when the initial diagnosis is made, continue or not continue the examination, because, as I said, the processes and treatment are connected, first of all, with the golden time that you spend thinking , doubt, listening to neighbors and an illiterate doctor.

Therefore, first of all, think about the fact that your life and the life of your unborn child are in your hands. nine0122