Physiologic edema

Symmetric, bilateral leg edema

Physical examination

Exclusion of other etiologies

Preeclampsia

Hypertension and proteinuria, with or without significant nondependent edema (eg, in face or hands), which, when present, is not red, warm, or tender

Sometimes, presence of risk factors for preeclampsia

When preeclampsia is severe, possibly additional symptoms of headache; pain in the right upper quadrant, epigastric region, or both; and visual disturbances

Possibly papilledema, visual field deficits, and lung crackles (in addition to edema), detected during physical examination

May progress to eclampsia (seizures)

Blood pressure

Urine protein

DVT

Tender unilateral swelling of a leg or calf, erythema, and warmth

Sometimes, presence of risk factors for DVT

D-dimer testing and/or lower-extremity duplex ultrasonography depending on level of suspicion (if low level, D-dimer as a screening test; if high level, lower-extremity duplex ultrasonography)

Peripartum cardiomyopathy

Symmetric, bilateral leg edema

Elevated jugular venous pressure (distended neck veins)

3rd heart sound (S3) heard during cardiac auscultation

Crackles, decreased breath sounds, detected during physical examination

Chest x-ray

ECG

Echocardiography

BNP or NT-proBNP

Cellulitis

Tender unilateral swelling in a leg or calf, erythema (asymmetric), warmth, and sometimes fever

Manifestations often more circumscribed than in DVT

Ultrasonography to rule out DVT unless swelling is clearly localized

Examination for source of infection