Background Lower limbs edema is one of the common problems in late pregnancy. This study aimed to determine the effect of modified Berger–Allen exercises on lower limb swelling in late pregnancy.
Materials and Methods This randomized clinical trial was conducted on 105 pregnant women suffering from lower limbs edema. Samples were randomly placed in three groups: modified Buerger–Allen exercises for five days, modified Buerger–Allen exercises for ten days, and the control group. Foot circumferences and volume and pain were measured before and after the study.
Results There was a significant difference between the average of right and left ankle circumference, right and left heel circumference, right and left foot circumference, left foot volume and pain score after the 5-day intervention group (p < 0.05). In the 10-day intervention group, there was a significant difference in all averages of ankles, heels, foot circumference and volume, and pain score 10 days after the intervention, compared to before the intervention (p < 0.05).
Conclusion Performing innovative modified Buerger–Allen exercises in pregnant women with lower limbs edema may reduce their pain and swelling. It can also reduce the leg areas in pregnant women with lower limb edema in late pregnancy
Keywords : Edema · Lower limb · Pregnancy · Modified Buerger–Allen exercise
Pregnancy is one of the most important stages in a woman’s life. Although it is a blissful period for most women, it seems to be a stressful period attributed to physiological and psychological changes [1]. It can be the origin of many changes in the body system, changes that can take a few weeks to return to the original [2]. Some of these changes affect the lower body organs [3]. Affecting 80% of pregnant women, edema is not considered as a symptom of pregnancy-induced hypertension or preeclampsia [4]. Varney describes gestational edema as excessive fluid accumulation in tissues without hypertension or proteinuria [4, 5]. Lower limb edema occurs in 35–80% of all normal pregnancies in late pregnancy [6].
A study, conducted in India in 2015 reported that the prevalence of swelling is as such was 67%, in pregnant women, 49% in legs, 33% in the sacral area, and 14% [7] in both areas. According to a study conducted in Turkey, the prevalence of physiological leg edema was 80% [6]. In another study in Iran, the such prevalence was between 26 and 62.2% [8, 9]. Despite the fact that physiologic edema during pregnancy is not dangerous, the pain associated with it may be the most serious complication. Also, nocturnal cramps, numbness (weakness), paleness, discomfort, feeling of heaviness in the leg, painful paresthesia, and change in the shape of the leg are other symptoms associated with edema [10]. Physiological edema in the feet can be one of the causes of sleep problems and disorders. Insufficient sleep (6 h or less) reported to cause prolonged labor and increase the prevalence of instrumental delivery [11]. Thus, evaluating and treating such a problem seems necessary. Buerger–Allen exercises may lead to the movement of interstitial fluids in the extravascular space as well as the venous system of blood circulation. It can be done by combining two mechanisms: 1. the movement of fluid in the extravascular space and 2. the movement of fluid from the extravascular space to the venous system. It does not have medical consequences [12]. Additionally, most pregnant women, who are in the third trimester, cannot sleep on their backs for a long time. It can lead to putting pressure on the great vein below, slowing down the return of blood to the heart, and restricting blood flow to the fetus [13]. Studies show that placing a pregnant mother in the position of sleeping on her back can increase the chance of still birth and IUGR [14, 15] at the end of pregnancy (third trimester). In the present study, we present the modified Buerger–Allen exercises that tilt the pregnant woman’s body to the left (the left lateral tilt (LLT) position replaced the supine position), to remove the pressure of the fetus from the collapsed inferior vena cava to the left aorta, which is resistant to compression. Also, this can increase the speed of blood flow [13]. Because limited studies have been conducted on the treatment of edema related to pregnancy, and according to the limitation of lying pregnant women in the supine position during Berger–Allen exercises, the present study aimed to determine the effect of modified Berger–Allen exercises on the physiological peripheral edema of pregnancy in the lower limbs.
Conflict of interest The author declares that there is no conflict of interest in this article.
Ethics approval and consent to participate The ethics code of this study has been approved by the Ethics Committee of Tarbiat Modares University (IR. MODARES. REC. 1399.105), and written informed consent has been obtained from all participants in the study.
