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Sunday
Jan172010

Pitting Edema

Here, a mom has what is called "pitting edema."

The pressure mark on the upper right of the photo is what I'm referring to.

Edema is measured by pressing the thumb into the flesh and seeing how long the indentation remains as well as how deep it goes. Reading around the Net, you would wonder why some grade it one way and other sites a different way. This is how I learned.

1+ Slight pitting, no visible change in the shape of the extremity, depth of indentation 0-1/4" (<6 mm); disappears rapidly
2+ No marked change in the shape of the extremity; depth of indentation 1/4-1/2" (6-12 mm); disappears in10-15 seconds
3+ Noticeably deep pitting, swollen extremity, depth of pitting 1/2-1" (1 -2.5 cm); duration 1-2 minutes
4+ Very swollen and distorted extremity, depth of pitting > 1" (>2.5 cm); duration 2-5 minutes

The edema in the picture was a +3, disappearing right at a minute and a few seconds.

Edema in pregnancy is pretty normal, but the more swelling there is, not only does the woman get more uncomfortable, but, depending on how extensive the edema is, it can herald some possible complications, including Pregnancy Induced Hypertension, Preeclampsia or HELLP Syndrome. This is not meant to be a treatise on edema, but merely to show what it looks like.

I will mention, however, that many midwives prescribe baths full of water with the addition of Epsom Salt. The medical name for Epsom Salt is Magnesium Sulphate, the medicine used during labor when a woman has blood pressure issues. Given through an IV, the medication helps keep seizures at bay. In the bath, however, it helps the body find balance by removing as much excessive swelling as possible; what remains is a clear clinical picture of what is happening.

We could discuss the complications for days, but I'm going to leave that for another few posts. Besides, Googling, one can find infinite amounts of information about any of the above terms.

I'm glad I could get this picture; it's not often I have a client with this much edema.

 

 

Reader Comments (5)

My uncle had type 4 for years, it was due to a thickening of his pericardium - more then 1" at places, got to see photos of his heart before they ripped the pericardium off, he's fine now without the constriction shutting his heart down. Dad had type 3 due to advanced hypothyroidism. They were both very very ill, and anyone with that kind of edema whether pregnant or not should be very alarmed by such edema.

January 17, 2010 | Unregistered CommenterEthel

Take a look at a nurse's ankles at the end of an 8 hr shift. +3/+4 pitting edema. Big time. Thank goodness from compression stockings!!!

January 17, 2010 | Unregistered Commenteratyourcervix

Eek!

My mama is a server (for 36 years now, at Disney World) and she, too, has horrid edema after her shifts. She lives her off time with her feet up.

January 17, 2010 | Registered CommenterNavelgazing Midwife

I have pitting edema while pregnant off and on and do not have it when I'm not. There is no reason to be alarmed by this. As a PT, I've treated extreme cases of edema that cause wounds and severe disability.

May 16, 2010 | Unregistered CommenterpregnantPT

Thanks for the information on the bath with epsom salts!!! Very useful information.

December 21, 2010 | Unregistered CommenterChuck

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