Differential Diagnosis of Bilateral Leg Swelling in Pregnancy
Single Most Likely Diagnosis
- Physiological edema of pregnancy: This is the most common cause of bilateral leg swelling in pregnancy, resulting from increased venous pressure and fluid retention due to the pregnancy itself. It is usually mild and symmetric.
Other Likely Diagnoses
- Deep Vein Thrombosis (DVT): Pregnancy increases the risk of DVT due to venous stasis, hypercoagulability, and vascular wall injury. It typically presents with unilateral swelling, but can be bilateral in some cases.
- Varicose veins: These are common in pregnancy due to increased venous pressure and can cause bilateral leg swelling.
- Preeclampsia: While preeclampsia can cause generalized edema, it is less common than physiological edema and usually accompanied by hypertension and proteinuria.
Do Not Miss Diagnoses
- Pulmonary embolism (PE): Although it may not directly cause bilateral leg swelling, PE is a life-threatening condition that can occur in conjunction with DVT. It requires immediate attention.
- Severe preeclampsia or eclampsia: These conditions can lead to significant morbidity and mortality if not promptly recognized and treated.
- Cardiac disease: Pre-existing or pregnancy-induced cardiac conditions can cause bilateral leg swelling due to heart failure.
Rare Diagnoses
- Nephrotic syndrome: A condition characterized by heavy proteinuria, hypoalbuminemia, and edema. It is rare in pregnancy but can cause significant bilateral leg swelling.
- Lymphedema: Although rare, lymphedema can occur in pregnancy, especially if there is a pre-existing condition or injury to the lymphatic system.
- Thyroid disorders: Both hypothyroidism and hyperthyroidism can cause edema, although this is less common in pregnancy.
- Idiopathic edema of pregnancy: A rare condition where the edema is not attributed to any other cause, and its pathophysiology is not well understood.