A 32-week pregnant woman complains of swelling in her legs, headache, and blurred vision. Examination reveals a 3 kg weight gain in one week. What is the most likely cause?

1. A

   Multiple pregnancy

2. B

   Normal pregnancy

3. C

   Gestational DM

4. D

   Pre-eclampsia

Appeared in: Raj. CHO -2024

Explanation

• The combination of rapid weight gain (3 kg in a week), edema (swelling), headache, and blurred vision in the third trimester is a classic presentation of pre-eclampsia.
• Rapid weight gain is a result of generalized edema and pathological fluid retention, a key sign of the condition.
• Headache and blurred vision are considered severe features, indicating central nervous system involvement and vasospasm, which require immediate medical evaluation and management.

Why Other Options Were Wrong

• Option A: While a multiple pregnancy can cause increased weight gain and edema, it does not typically cause the neurological symptoms of severe headache and blurred vision.
• Option B: The symptoms presented, particularly the rapid 3 kg weight gain, severe headache, and blurred vision, are pathological and not features of a normal, uncomplicated pregnancy.
• Option C: The primary signs of Gestational Diabetes Mellitus relate to hyperglycemia (e.g., polydipsia, polyuria) or fetal macrosomia. It does not directly cause the triad of headache, vision changes, and rapid fluid retention.

Related Visual

• Visual 1: Diagram - Pathophysiology of pre-eclampsia, showing how abnormal placental development leads to endothelial dysfunction, vasospasm, and end-organ damage.
• Visual 2: Chart - A comparison chart detailing the signs and symptoms of normal pregnancy versus the warning signs of pre-eclampsia, including blood pressure, proteinuria, weight gain, and neurological symptoms.

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Diagnosis of Pre-eclampsia based on clinical signs and symptoms as background academic context rather than a clinical decision trigger.
• A nurse's immediate actions for a patient with these symptoms include measuring blood pressure, performing a urine dipstick test for proteinuria, and immediately notifying the healthcare provider. These are critical steps because pre-eclampsia can rapidly progress to eclampsia (seizures).
• Patient education on recognizing and immediately reporting danger signs (severe headache, visual changes, epigastric pain, rapid swelling) is a crucial nursing role in antenatal care to ensure timely intervention.
• What if? If the patient's blood pressure was found to be severely elevated (e.g., greater than 160/110 mmHg), she would require immediate hospitalization and administration of antihypertensive medications and magnesium sulfate for seizure prophylaxis, with delivery being the definitive treatment.

How to Approach the Question

• First, identify the key patient information: a 32-week pregnant woman.
• Next, analyze the cluster of symptoms presented: swelling in the legs (edema), headache, blurred vision, and a rapid weight gain of 3 kg in one week.
• Recognize that this combination of symptoms, especially the neurological signs (headache, vision changes) and pathological weight gain, forms a classic clinical picture.
• Evaluate each option against these hallmark signs. A normal pregnancy would not present with such severe symptoms. Gestational diabetes has a different symptom profile (related to blood sugar). Multiple pregnancy doesn't typically include neurological signs.
• Conclude that the symptom triad strongly points to pre-eclampsia, a serious hypertensive disorder of pregnancy.

Concept Tested & Keywords

• Concept Tested: Diagnosis of Pre-eclampsia based on clinical signs and symptoms.
• Stem keywords: 32-week pregnant, swelling in legs, headache, blurred vision, 3 kg weight gain
• Lead-in keywords: most likely cause
• Clinical cues: Sudden weight gain of 3 kg in one week suggests pathological fluid retention.
• Clinical cues: Headache and blurred vision are neurological signs pointing to severe disease features.

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