During antenatal assessment, you can see a blotchy, brownish, hyperpigmentation of the skin over the cheeks, nose, and forehead of a pregnant woman. What is this change called as?

1. A

   Chloasma

2. B

   Linea Nigra

3. C

   Striae gravidarum

4. D

   Vascular spider

Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2019

Explanation

• Chloasma, also known as melasma or the 'mask of pregnancy,' is characterized by blotchy, brownish hyperpigmentation on the face.
• It typically appears on sun-exposed areas like the cheeks, nose, and forehead.
• The condition is caused by increased levels of hormones during pregnancy, such as estrogen, progesterone, and melanocyte-stimulating hormone, which stimulate melanin production.
• Chloasma is a benign (harmless) condition that usually fades on its own within a few months after delivery.

Why Other Options Were Wrong

• Option B: Linea nigra is a dark, vertical line that appears on the midline of the abdomen during pregnancy, not blotchy patches on the face.
• Option C: Striae gravidarum are stretch marks. They appear as reddish or purplish linear streaks, not brownish patches, and are commonly found on the abdomen, breasts, and thighs.
• Option D: Vascular spiders (spider angiomas) are small, red, spider-like vascular lesions that blanch with pressure. They are not brownish, blotchy patches of hyperpigmentation.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Physiological skin changes during pregnancy to guide bedside assessment, documentation, and the next nursing action.
• Nurses should reassure the patient that chloasma is a common and harmless physiological change of pregnancy that typically resolves after delivery.
• Patient education is key. Advise the use of broad-spectrum sunscreen (SPF 30 or higher) and wearing a wide-brimmed hat, as sun exposure can worsen the pigmentation.
• What if? If the hyperpigmentation persists for more than a year postpartum and causes significant cosmetic distress, the nurse can advise the patient to consult a dermatologist for potential treatments like topical lightening agents or laser therapy.

How to Approach the Question

• This is a factual recall question based on knowledge of physiological changes in pregnancy.
• First, identify the key descriptors in the question stem: 'blotchy, brownish, hyperpigmentation' and the specific location 'cheeks, nose, and forehead.'
• Systematically review the options provided and recall the definition for each term.
• Match the description in the stem to the correct term. The facial 'mask of pregnancy' is a classic sign of Chloasma.
• Rule out the other options by confirming their different locations and appearances: Linea Nigra (abdominal line), Striae gravidarum (stretch marks), and Vascular spider (red vascular lesions).

Concept Tested & Keywords

• Concept Tested: Physiological skin changes during pregnancy
• Stem keywords: antenatal assessment, blotchy, brownish, hyperpigmentation, cheeks, nose, forehead, pregnant woman
• Lead-in keywords: What is this change called as
• Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.

Question ID

QP_zbVnpxjVDYfa-H7YioP

Copy ID

Reference Book

E6 Obstetrics Williams p. 40-59