Why in the last month of pregnancy the legs swell

If during pregnancy the weight of a womanincreases by an average of 10 kg, then of them not less than 5-6 kg (or rather, liters) falls on water. The fluid is retained in virtually all tissues, except for the bone, but in varying degrees. Especially intensively it accumulates in connective tissue and fatty tissue. Water passes into tissues from the blood, the amount of which during pregnancy increases by 40-50%.

May Shehtman
Professor, Doctor of Medical Sciences, Academician of the International Academy of Informatization

How and why do edema appear

The process of water retention in the body of a pregnant womana woman does not start right away. In the first three months of pregnancy, it is rarely seen. And then gradually the woman herself starts to note that the skin on the arms, legs, stomach loses its elasticity and elasticity, it becomes as if loose. Later, the roundness of the face increases, which people who know the woman are beginning to pay attention to. Finally, in the last three months of pregnancy often swelling of the legs and to a lesser extent the hands, face, lower back, abdomen. Pressing a finger on the shin skin in front, where the bone is covered only by the skin (there is no muscle in this area), leaves a hole that is not immediately filled. This is a clear sign of the presence of edema. The threatening appearance of edemas or their growth is judged by a sharp increase in body weight. With normal development of pregnancy, the body weight increases gradually; From this point of view, a regular weighing of a pregnant woman is necessary.

There are also more sophisticated instrumental methods that can diagnose the appearance of edema, when they are not yet visible, but these methods have not received wide practical application.

It is established that in the body of a pregnant womanaccumulates sodium, and evenly - both in the vascular bed (in the blood) and in soft tissues. Sodium has the ability to attract water. Due to the propensity of pregnant women to delay sodium and water, they can, as already mentioned, develop physiological edema . especially after provoking factors (thiscan be abuse of salty foods, physical overload, hot weather). Such swelling is natural, they appear in many women and do not pose a danger to their health.

Unlike pathological edema, which are symptoms of the disease,physiological edemas easily disappear after the elimination of provoking factors in a state of physical rest and especially in the position on the left side. This position is optimal for kidney function and improves the passage of urine through the urinary tract. Physiological edema develops in different periods of pregnancy in about 80% of healthy women and does not require special treatment.

On the development of complications of pregnancy, definedas dropsy pregnant, they say, when along with an excessive increase in body weight appear persistent edema. Dropsy of pregnant women can be expressed dramatically: weight gain of 20 kg or more, massive swelling of the legs, face, hands, loin, abdominal wall. A woman becomes hard to put on her shoes, clench her fingers in a fist, bend down, her eyes look small because of the puffiness of her eyelids.

Fortunately, the fetus suffers little or nosuffers completely. This initial form of gestosis is reversible. And it must be treated, otherwise the dropsy may pass into a heavier form of gestosis, accompanied, in addition to edema, by an increase in blood pressure, the release of protein with urine and other signs, including intrauterine fetal suffering.

During pregnancy,pay attention to the consumption of liquid and table salt. A healthy pregnant woman consumes 1.5-2 liters of liquid per day (not only drinks, but also soups and fruits), sometimes more. If there is no edema and the body weight increases evenly, then the processes of consumption and discharge of water are balanced and there is nothing to change. This applies to the amount of sodium consumed (most often in the form of table salt, which is abundant in sauerkraut, pickled cucumbers, herring, black bread).

The reason for the correction of the diet is the appearance of notdisappearing overnight swelling or uneven, excessive weight gain. In this case, you need to reduce the consumption of liquids to 1 liter, but not less, because Water is a necessary ingredient in the metabolism, including during pregnancy. No wonder, as already mentioned, during this period, its amount in the body increases significantly. With food, nutrients enter the cells and waste products of metabolism are released.

Due to what it is possible to reduce the quantityconsumed fluid? From the point of view of the volume of water, this is insignificant. However, for example, vitamins are contained in juices, and tea and coffee of great value for a pregnant woman do not represent. Fruits (apples, pears, grapes and others) are largely composed of water, so when calculating the volume of the liquid you need to consider the actual weight of the fruit. In other words, if you ate an apple weighing 200 g, you need to add 200 ml to the fluid consumed per day.

An attempt to eliminate swelling only at the expense ofreduction of consumed liquids is doomed to failure, if at the same time sodium intake in the form of table salt will not be reduced. It is sodium molecules that are bound in the body with water molecules and prevent it from being secreted by the kidneys. Therefore, it is very important to remove salted cucumbers, herring, sauerkraut, salted peanuts, and black bread from the diet. The food that a woman prepares for herself, she should not nedosalivat. Of course, sodium, like water, is needed by the body. But to be afraid of its deficiency it is not necessary: ​​this element is contained in many food products, and the woman receives it in sufficient quantity.

Moderately expressed dropsy of pregnant women caneliminate only with the help of diet regulation. If these measures are not enough, resort to the appointment of diuretics. In recent years, these funds have been used less frequently, since sodium and water released in the urine as a result of their intake can reduce the volume of circulating blood and help increase pressure. However, this is important in the gestosis of pregnant women, which increased blood pressure.

So far, we have talked about swelling as a manifestation of a normally occurring or complicated pregnancy gestosis. Edema "heart" and "kidney" is much less common.

In women with heart disease (for example, withheart disease) edema can occur due to heart failure. They are always located in the lower parts of the body: if a woman walks, then on her legs, if she is, then on her lower back. Puffiness of the hands, face practically does not happen. To clarify the cause of edema, doctors determine the size of the liver. With "cardiac" edema, the liver first increases, then swelling develops. With edema due to gestosis (dropsy, nephropathy), the liver is not enlarged. In addition, with heart failure, the appearance of edema is preceded by persistent palpitation, dyspnea, bluish coloration of mucous membranes (in gestosis, these symptoms are absent).

"Renal" swelling occurs with somekidney diseases, for example, with acute and some forms of chronic glomerulonephritis (inflammatory kidney disease of an immunoallergic nature), although most of the urological diseases that occur in pregnant women are without edema (pyelonephritis, urolithiasis, etc.). With "kidney" swelling appear puffiness of the face, bags under the eyes, later - swelling of the legs and hands. As a rule, a woman knows that she has kidney disease, but such a disease can occur during pregnancy, which creates certain diagnostic difficulties, overcome by additional research. "Renal" edema occurs with specialized treatment of the underlying disease, which is prescribed by a nephrologist or urologist. When these diseases occur or worsen during pregnancy, treatment is performed in a hospital setting. In conclusion, I want to reiterate that physiological edema is one of the signs of pregnancy and should be treated calmly. Pathological edema requires treatment and, above all, the restriction of table salt and water. The normal course of pregnancy edema does not break, but they can be harbingers of the development of a more serious disease, so you can not pay no attention to them.

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