edema in the postpartum period

[yellowbox]

Hi,

I've been working in postpartum for a few months and love it. I have 345346 questions but I will limit this post to one...maybe two! Edema in the postpartum period is the main focus of this post - I have searched my books and online and can't find too much information.

- Is pittiing edema in the lower and upper extermities (bilateral) considered "normal" in the postpartum period?

- I understand it can be associated with preeclampsia. I really want to know more about the pathophysiology behind that if anybody has a resource..

- Can you suggest any other nursing interventions other than elevation of the extremity? I've read to increase fuids too to flush it out? Ambulation?

- What assesments should I do to rule out any serious problems? (Listen for crackles to rule out pulmonary edema, check swelling is bilateral and homan's sign to r/o DVT, ask about headache & check blood pressure to r/o eclampsia...)

- How long does the swelling usually take to go away?

Huge huge thanks to any of you who are willing to share your time and expertise!

[greenykilt]

you will find alot of interesting information from www.preeclampsia.org the non profit pre eclampsia (and HELLP and etc) site. Browsing the forums is very interesting as well.

[NurseNora, BSN, RN]

I bet that you'll find that the patients who had epidurals have the most edema (other than real preeclamptics). We tend to run in lots and lots of fluids in our epidural patients which dilutes the albumin and electrolytes in the plasma that pulls fluids out of the interstitial space and back into circulation. It's not unusual for pregnant women to have mild pitting edema of the lower extremities; we sometimes make it worse by overloading our patients with IV fluids. They usually start diuresing in a day or two.

[mommybess, BSN, RN]

There are a few reasons for it. Increased maternal blood volume during pgy = body shifts extra volume to tissues where they are safe, pt diuresis and or sweats extra volume out over a few days.

IV fluids increase vascular volume... which increases the above.

Pitocin causes fluid retention. Many pts receive Pit during labor.