A female with 34 week pregnancy comes in clinic with the complaint of Heartburn during pregnancy due to which… - NORCET 10 Prelims-2026

NORCET 10 Prelims-2026

Obstetrics & Gynaecology

Hard

Appeared in: NORCET 10 Prelims-2026

Explanation

The primary cause of heartburn in pregnancy is the hormonal effect of progesterone.
Progesterone is a smooth muscle relaxant. It causes the lower esophageal sphincter (LES), the valve between the stomach and esophagus, to relax.
This relaxation allows acidic stomach contents to reflux back into the esophagus, leading to the characteristic burning sensation known as heartburn.

Option B: While increased pressure from the growing uterus is a significant contributing factor that worsens heartburn, it is not the primary underlying cause. The reflux is initially made possible by the hormonal changes affecting the sphincter.
Option C: This is physiologically incorrect. Evidence suggests that gastric acid and pepsin secretion are often reduced during pregnancy, not increased.
Option D: Decreased intestinal motility, also an effect of progesterone, primarily slows the transit of food through the intestines, leading to increased water absorption and constipation.

Visual 1: Diagram - An illustration comparing a normal, closed lower esophageal sphincter (LES) to a relaxed LES in pregnancy, showing how acid can reflux from the stomach into the esophagus.
Visual 2: Anatomical Illustration - A depiction of a pregnant woman in the third trimester, showing the enlarged uterus pressing upwards on the stomach, displacing it and increasing intragastric pressure.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pathophysiology and management of heartburn (pyrosis) during pregnancy as background academic context rather than a clinical decision trigger.
Nurses play a vital role in educating pregnant clients about non-pharmacological management of heartburn, such as eating small, frequent meals, avoiding trigger foods, and maintaining an upright posture after eating.
It is crucial to distinguish common heartburn from epigastric pain that could be a symptom of severe pre-eclampsia, especially in the third trimester. Epigastric pain is often described as more severe, constant, and located in the upper right quadrant.
What if? If the patient described the pain as severe, constant, and located in the upper right quadrant, accompanied by headache or visual changes, the nurse must immediately assess for other signs of pre-eclampsia/HELLP syndrome, such as elevated blood pressure, and notify the provider urgently.

How to Approach the Question

Identify the core of the question: It asks for the physiological reason for heartburn in a late-stage pregnancy (34 weeks).
Recall the major physiological changes in pregnancy: these are hormonal (e.g., increased progesterone) and mechanical (e.g., enlarging uterus).
Evaluate each option based on this knowledge. Option A (hormonal relaxation of LES) and Option B (mechanical pressure) are both known factors.
Differentiate between the primary underlying cause and a contributing/exacerbating factor. The hormonal change (A) is the primary enabler of reflux, while the pressure (B) makes it worse.
Eliminate physiologically incorrect options. Gastric acid does not increase (C), and decreased motility (D) is more directly related to constipation.
Select the option that represents the most fundamental physiological cause, which is the relaxation of the LES due to hormones.

Concept Tested & Keywords

Concept Tested: Pathophysiology and management of heartburn (pyrosis) during pregnancy.
Stem keywords: 34 week pregnancy, Heartburn, correct reason
Lead-in keywords: correct reason
Clinical cues: 34 week pregnancy: This indicates the third trimester, a time when mechanical pressure from the enlarged uterus significantly contributes to and exacerbates heartburn symptoms.
Negative lead-in flag: false

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