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Zorluk: KolayNormal Pregnancy and Prenatal Care

A 28-year-old woman, gravida 2, para 1, at 34 weeks gestation presents to the clinic for a routine scheduled visit. She reports that her shoes have felt increasingly tight over the past two weeks and she has noticed swelling in both of her ankles. The swelling progressively worsens throughout the day but improves significantly after she sleeps at night. She denies any headaches, visual changes, right upper quadrant pain, chest pain, or shortness of breath. Vital signs include a blood pressure of 116/74 mm Hg, a heart rate of 82/min, and a respiratory rate of 14/min. Physical examination reveals 1+ pitting edema of the bilateral lower extremities extending up to the ankles. Deep tendon reflexes are 2+ and symmetric. Urinalysis is negative for protein and glucose. Which of the following is the most appropriate next step in management for this patient's symptoms?

  1. Advise resting in the lateral decubitus position and elevating the lower extremitiesCevap
  2. B
    Admit to the hospital for a 24-hour urine protein collection
  3. C
    Prescribe a low-dose loop diuretic for symptom relief
  4. D
    Obtain a comprehensive metabolic panel to evaluate hepatic function
  5. E
    Perform bilateral lower extremity venous Doppler ultrasonography

Cevap

The correct approach is to advise the patient to rest in the lateral decubitus position and elevate her legs, as her presentation is consistent with benign dependent edema of pregnancy.
This patient is presenting with isolated, bilateral lower extremity edema that worsens throughout the day and improves with rest. Along with a normal blood pressure and absence of proteinuria, this is a classic presentation of physiologic dependent edema of pregnancy. During the third trimester, edema is common due to sodium and water retention, as well as mechanical compression of the inferior vena cava and pelvic veins by the gravid uterus. Management is conservative and includes advising the patient to rest in the left lateral decubitus position (which relieves caval compression) and to elevate her lower extremities.

Adım Adım Çözüm

1
Evaluate the patient's symptoms and vital signs.
The patient has bilateral dependent edema, is normotensive (116/74 mm Hg), and lacks symptoms of severe disease such as headache or visual changes.
To differentiate benign physiologic edema from hypertensive disorders of pregnancy, such as preeclampsia.
2
Review the urinalysis results.
The urinalysis is negative for protein.
The absence of proteinuria further rules out preeclampsia, confirming the swelling is likely physiologic.
3
Determine the appropriate management.
Recommend conservative management with leg elevation and lateral positioning.
The patient is experiencing a normal physiologic change of late pregnancy, requiring only symptomatic, supportive care.

Anahtar Kavram

Management of physiologic dependent edema of pregnancy
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Konular

Normal Pregnancy and Prenatal Care

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