Severe Edema in Pregnant Women: Causes and Concerns

Q: Severe Edema in Pregnant Women: Causes and Concerns

Ms. <br>Yang： Hello. <br><br>1. <br>Is the direction of the above suspicions correct? Are there any other possibilities that may not have been considered? The three most common organs affected by edema—heart, liver, and kidneys—are all functioning properly, so the physician has t

Edema in pregnant women?

Hello Dr.
Chen: My sister-in-law is 37 years old and during her seventh month of pregnancy, she suddenly developed full-body edema after taking cold medication, which has persisted for over a month.
Her neck is also swollen, to the point that it is affecting her breathing.
She has undergone multiple tests, but no cause has been identified.
It has been confirmed that there is no gestational hypertension, and her heart, liver, and kidneys are functioning properly, with no signs of thrombosis.
The hospital is now suspecting whether there are tumors in her neck or lungs, and if a tumor is confirmed, an emergency cesarean section will be necessary regardless of whether it is benign.

I would like to ask:
1.
Is the direction of the above suspicions correct? Are there any other possibilities that have not been considered? What methods can be used to preliminarily assess these concerns in pregnant women? Or is it purely based on the physician's clinical experience?
2.
While waiting for the biopsy results, what risks does this systemic edema pose to the fetus and the mother? Are there any precautions to take during this waiting period?

Yang Huique, 30~39 year old female. Ask Date: 2012/10/04

Dr. Chen Sirong reply Oncology

Ms.
Yang: Hello.

1.
Is the direction of the above suspicions correct? Are there any other possibilities that may not have been considered? The three most common organs affected by edema—heart, liver, and kidneys—are all functioning properly, so the physician has to look for other causes, and this progression is appropriate.
There may be other possibilities and directions, but as an oncologist, I can only say that a PET scan to rule out tumors should be done after delivery.
For a whole-body MRI to rule out tumors, you can inquire with the Taichung Veterans General Hospital MRI Health Check Center at 04-2359-7890 to see if it is safe for pregnant women.
After ruling out tumors, it is still necessary for an obstetrician to consider other possibilities.
2.
What methods can a pregnant woman use to preliminarily assess the above direction? Or is it purely based on the physician's clinical experience? The three most common organs affected by edema—heart, liver, and kidneys—are all functioning properly, so the physician has to look for other causes, and this progression is appropriate.
This is what the textbooks teach, and it is also supported by the clinical experience of senior physicians.
3.
While waiting for biopsy results, what dangers or precautions should be considered regarding systemic edema for the fetus and the pregnant woman? This question can only be answered by an obstetrician, so please consult the attending physician directly.
4.
If a tumor is confirmed, regardless of whether it is benign or malignant, an emergency cesarean section is required.
I would like to clarify that I do not necessarily agree with this; it depends on the type of tumor, and it should be discussed with specialists who treat such tumors along with the obstetrician and your family.
If the mother's condition is critical and requires urgent treatment, and if the fetus is viable, then delivery can certainly proceed immediately.
There are situations where treating the mother will have an acceptable impact on the fetus, so immediate treatment is still possible.
For example, during my time at National Taiwan University Hospital, I treated a pregnant woman with nasopharyngeal cancer using radiation therapy for head and neck cancer while protecting the fetus with lead shielding.
The fetus will still receive some scatter dose, but based on past experiences, it does not typically cause malformations or miscarriages.
In another scenario, if a pregnant woman is diagnosed with cancer and chooses to delay treatment for a month or two, and if this does not significantly affect her condition, she can certainly choose to wait 1-2 months.
After all, cancer is a chronic disease, especially in the early stages.
Therefore, decisions should be based on the pregnant woman's condition and the maturity of the fetus, rather than a blanket rule that all benign or malignant tumors require immediate treatment.

Thank you for your letter.

Sincerely,
Chen Si-Rong

Reply Date: 2012/10/04

More Info

Severe edema in pregnant women can be a concerning symptom, especially when it occurs suddenly and is accompanied by other symptoms such as difficulty breathing. In the case of your sister-in-law, who is 37 weeks pregnant and has developed significant edema after taking cold medication, it is crucial to consider several potential causes and implications for both her and the fetus.

Understanding the Causes of Severe Edema
1. Physiological Changes in Pregnancy: During pregnancy, women naturally experience increased blood volume and fluid retention, which can lead to mild edema. However, sudden and severe edema, especially when localized (like in the neck) or accompanied by respiratory issues, may indicate an underlying problem.

2. Possible Pathologies:
- Allergic Reactions: It’s possible that the cold medication triggered an allergic reaction, leading to angioedema, which can cause swelling in deeper layers of the skin and tissues, including the neck and face.

- Thyroid Issues: Pregnancy can exacerbate pre-existing thyroid conditions, which can also lead to swelling.

- Tumors: As the medical team suspects, tumors in the neck or lungs could lead to obstruction of lymphatic drainage or vascular compression, resulting in edema. This is a serious concern and warrants thorough investigation.

- Cardiac or Renal Issues: While initial tests have ruled out significant cardiac and renal problems, these systems can sometimes present with edema in complex ways.

Diagnostic Approaches
To investigate the cause of the edema, several diagnostic tests can be employed:
- Ultrasound: This can help visualize any masses in the neck or abdomen.

- CT or MRI: These imaging techniques can provide detailed views of the neck and chest to identify any tumors or structural abnormalities.

- Blood Tests: Checking thyroid function, liver enzymes, and kidney function can help rule out systemic issues.

Risks and Considerations for the Mother and Fetus
1. Impact on the Fetus: Severe edema can lead to complications such as preterm labor or placental insufficiency, which can affect fetal growth and well-being. If the edema is due to a serious underlying condition, such as a tumor, this could pose additional risks.

2. Maternal Health: The swelling, especially if it affects breathing, can lead to significant discomfort and may require immediate medical intervention. If the swelling is due to an allergic reaction or a tumor, timely treatment is crucial to prevent further complications.

Recommendations During the Waiting Period
While waiting for biopsy results, it is essential to monitor the following:
- Breathing Difficulties: If breathing worsens, immediate medical attention is necessary.

- Fluid Intake: Encourage adequate hydration unless contraindicated by a healthcare provider.

- Rest: Adequate rest can help manage symptoms and reduce stress on the body.

- Monitoring Symptoms: Keep track of any new symptoms, such as increased swelling, pain, or changes in fetal movement.

Conclusion
In summary, severe edema in a pregnant woman, especially when it is sudden and accompanied by respiratory issues, requires thorough investigation to rule out serious conditions. The medical team’s suspicion of a tumor is a valid concern, and appropriate imaging and tests should be conducted. During this waiting period, close monitoring of both maternal and fetal health is essential. It is crucial for your sister-in-law to maintain open communication with her healthcare providers and report any changes in her condition promptly.

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