Physiological Changes in Pregnancy

A 32-year-old multiparous woman at 32 weeks of gestation presents with complaints of increased urinary frequency and mild dysuria. Urinalysis shows glycosuria (2+) and mild proteinuria (trace). Blood pressure is 128/82 mmHg (baseline 110/70 mmHg), and random blood glucose is 145 mg/dL. Serum creatinine is 0.6 mg/dL (normal non-pregnant range 0.6–1.2 mg/dL). The patient is concerned about developing diabetes and kidney disease. What is the most appropriate explanation for these findings?

Which of the following cardiovascular changes occurs earliest in pregnancy and persists throughout gestation?

A 28-year-old primigravida at 24 weeks of gestation presents to the antenatal clinic for a routine check-up. She complains of mild dyspnea on exertion and occasional palpitations, which she attributes to climbing stairs at her workplace. On examination, her blood pressure is 110/68 mmHg (baseline 105/65 mmHg), heart rate 88 bpm, and respiratory rate 18/min. Cardiac auscultation reveals a soft systolic murmur at the left sternal border. Chest X-ray shows mild cardiomegaly with straightening of the left heart border. Echocardiography demonstrates a left ventricular ejection fraction of 52% (normal >55%), mild left ventricular dilation, and trivial mitral regurgitation. Complete blood count shows hemoglobin 10.2 g/dL. Which of the following best explains her clinical presentation?

During pregnancy, the glomerular filtration rate increases by approximately what percentage compared to the non-pregnant state?

A 32-year-old multigravida at 28 weeks of gestation presents for a routine antenatal visit. She reports swelling in her feet and ankles that worsens by evening. On examination, she has mild pitting edema of both lower limbs. Her blood pressure is 115/72 mmHg, and urinalysis shows no proteinuria. Serum albumin is 3.0 g/dL (normal: 3.5–5.0 g/dL). She is reassured that this is a normal finding. Which of the following best explains the pathophysiology of edema in this patient?