A G1P0 woman at 34 weeks comes for a routine antenatal visit. Which of the following findings is NOT a normal finding (exception) in pregnancy?

1. A

   Sudden onset of puffy face with inability to remove ring

2. B

   Ankle edema at the end of the evening

3. C

   . Mild backache

4. D

   Increased urinary frequency

Appeared in: NORCET 10 Prelims-2026

Explanation

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• Sudden swelling (edema) of the face and hands is a classic warning sign of preeclampsia, a serious hypertensive disorder of pregnancy.
• This type of swelling is considered non-dependent or pathological, as it is not related to gravity and indicates a systemic problem.
• The inability to remove a ring is a clear indicator of significant hand edema.
• Preeclampsia involves widespread endothelial dysfunction, leading to vasospasm and leakage of plasma into the interstitial space, causing generalized edema, hypertension, and potential organ damage.

Why Other Options Were Wrong

• Option B: Ankle edema that worsens throughout the day and resolves with rest is considered dependent edema. This is a normal physiological change in late pregnancy caused by the gravid uterus compressing the inferior vena cava and pelvic veins, which increases hydrostatic pressure in the lower limbs.
• Option C: Mild backache is a very common discomfort during pregnancy. It results from the shift in the center of gravity, postural changes, and the effects of hormones like relaxin, which soften ligaments.
• Option D: Increased urinary frequency is a normal symptom in the first trimester (due to hormonal changes and increased blood flow to the pelvis) and the third trimester (due to pressure from the descending fetal head on the bladder).

Related Visual

• Visual 1: Infographic - A side-by-side comparison of normal pregnancy discomforts (e.g., ankle swelling, backache) versus warning signs (e.g., facial swelling, severe headache, visual changes) to help learners differentiate between them.
• Visual 2: Illustration - An image depicting a pregnant woman with pitting edema in her hands and face, with a callout box explaining its link to preeclampsia.

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Differentiation between normal physiological changes and abnormal warning signs during pregnancy, specifically focusing on preeclampsia as background academic context rather than a clinical decision trigger.
• Nurses play a vital role in patient education, teaching pregnant women to distinguish between normal discomforts and potentially dangerous warning signs that require immediate reporting.
• During antenatal visits, a key nursing assessment is checking for signs of preeclampsia, including blood pressure measurement, urine protein testing, and inquiring about symptoms like swelling, headaches, or visual changes.
• Prompt identification and management of preeclampsia are critical to prevent severe complications for both the mother (e.g., eclampsia, HELLP syndrome, stroke) and the fetus (e.g., growth restriction, preterm birth, demise).

How to Approach the Question

• First, identify the core of the question: it asks for the ABNORMAL finding (the exception) among the given options for a woman in the third trimester.
• The use of 'NOT' means three of the options are normal, and one is abnormal.
• Evaluate each option based on standard physiological changes of pregnancy.
• Option A: 'Sudden onset of puffy face with inability to remove ring'. Sudden, generalized swelling, especially of the face and hands, is a well-known warning sign of preeclampsia.
• Option B: 'Ankle edema at the end of the evening'. This is classic dependent edema, which is very common and normal in late pregnancy.
• Option C: 'Mild backache'. This is a common musculoskeletal complaint due to postural changes and hormonal effects.

Concept Tested & Keywords

• Concept Tested: Differentiation between normal physiological changes and abnormal warning signs during pregnancy, specifically focusing on preeclampsia.
• Stem keywords: G1P0, 34 weeks, antenatal visit, NOT a normal finding, exception
• Lead-in keywords: NOT, exception
• Clinical cues: 34 weeks gestation: This places the pregnancy in the third trimester, a common time for preeclampsia to manifest.
• Clinical cues: G1P0: Nulliparity (first pregnancy) is a significant risk factor for developing preeclampsia.

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