Is postpartum (after childbirth) swelling of the hands and feet a normal part of the recovery process?

Postpartum Swelling of Hands and Feet

Leg swelling is a frequent finding in the postpartum period and is generally considered normal, particularly when it affects the lower extremities. 1 While most postpartum swelling is benign and self-limiting, it's important to distinguish between normal physiological changes and potentially concerning conditions that require medical attention.

Normal Postpartum Swelling

Postpartum swelling (edema) of the hands and feet is commonly experienced during the recovery process and typically results from:

• Excess fluid retention during pregnancy that needs time to be eliminated
• Hormonal changes that affect fluid balance
• Decreased mobility in the immediate postpartum period
• Normal physiological changes as the body returns to pre-pregnancy state

This swelling is particularly common in the first week after delivery and gradually resolves as the body eliminates excess fluid through increased urination.

When to Be Concerned

While swelling is normal, certain characteristics warrant medical evaluation:

• Asymmetric swelling (especially if one leg is significantly more swollen than the other)
• Sudden onset of swelling accompanied by pain, redness, or warmth
• Swelling accompanied by shortness of breath, chest pain, or headache
• Swelling that worsens rather than improves over time

These symptoms could indicate serious complications such as deep vein thrombosis (DVT), which occurs at a rate of approximately 1.4 per 1000 during pregnancy and puerperium, with about 57.5% of these events occurring in the postpartum period rather than during pregnancy 1.

Risk Assessment and Management

For Normal Postpartum Swelling:

• Elevation of affected extremities
• Adequate hydration
• Moderate physical activity as tolerated
• Compression stockings for lower extremity swelling
• Avoiding prolonged standing or sitting

For Women at Higher Risk:

Women with risk factors for venous thromboembolism (VTE) should be assessed and managed according to their risk level 1:

• High risk patients: Should receive antenatal prophylaxis with low molecular weight heparin (LMWH) as well as postpartum prophylaxis for 6 weeks
• Intermediate risk patients: Should receive postpartum prophylaxis with LMWH for at least 7 days or longer if more than 3 risk factors persist
• Low risk patients: Early mobilization and avoidance of dehydration is recommended

Diagnostic Approach for Concerning Swelling

If postpartum swelling raises concern for DVT:

1. Assess pre-test probability
2. Perform D-dimer testing
3. Conduct compression ultrasonography

If a proximal DVT is detected, treatment should be continued. Women with low pre-test probability and normal D-dimer should undergo serial compression ultrasonography on day 3 and after 1 week 1.

Recovery Timeline

It's important to note that complete postpartum recovery, including resolution of swelling, typically takes longer than the traditional six-week period often cited 2. Many women experience various recovery challenges throughout the first several months postpartum.

Key Points to Remember

• Bilateral swelling of hands and feet is common and usually resolves within the first 1-2 weeks postpartum
• Unilateral swelling, especially of the left leg, warrants closer attention due to higher risk of DVT
• A clinical decision rule considering three variables (left leg presentation, >2 cm calf circumference difference, and first trimester presentation) can help assess DVT risk 1
• Graduated compression stockings are recommended for women at high risk of VTE 1

If swelling persists beyond 2 weeks postpartum or is accompanied by concerning symptoms, medical evaluation is recommended to rule out complications such as DVT or other postpartum complications.