swelling in chronic hypertensives

[expert@preeclampsia.org]

I understand that edema has been abandoned as a marker for preeclampsia because most pregnant women have some swelling, and that even normal pregnancies can be marked by significant early swelling. However, is early swelling in some patients more worrisome? Should chronic hypertensives be more worried about swelling indicating oncoming preeclampsia, or are they at generally higher risk of swelling in even normal pregnancies?

[expert@preeclampsia.org]

You are correct swelling was removed from the diagnosis of preeclampsia over a decade ago as over half of women with uncomplicated pregnancies have swelling at some time during pregnancy, usually in the lower extremities “the dependent” variety. The remainder of the question is difficult to answer primarily because there are little data supporting the various clinical “impressions” one hears from their caregivers.

Certainly, edema in the absence of hypertension and proteinuria is nothing to be concerned about. Often this occurs after a bit more upright activity, especially in the 3d trimester, sometimes associated with salt binging (I write this when everyone is going to end of year holiday parties!). Some practitioners give more credence to "rapidly appearing edema" but again there are no data to back concern here. When I am consulted regarding what one considers excessive edema, and the patient is neither hypertensive nor proteinuric, I reassure everybody, but make sure pressure and urine are checked during the ensuing 2 weeks, reassuring the patient again.