Pregnancy-Induced Hypertension Practice Exam

EXPLANATION

✔Correct answer:

Clear and maintain an open airway. The first and most critical action when a patient progresses to eclampsia, which involves the onset of seizures, is to clear and maintain an open airway. During a seizure, the patient's ability to maintain their own airway is compromised, and they are at risk of airway obstruction, aspiration, and respiratory distress. Ensuring that the airway is clear and open is essential to prevent hypoxia, which can have severe consequences for both the mother and the fetus.

Eclampsia is a severe complication of preeclampsia characterized by the onset of generalized tonic-clonic seizures. These seizures can lead to a loss of consciousness, involuntary movements, and impaired airway protective reflexes. If the airway is not managed promptly, the patient can aspirate gastric contents, or their airway can become obstructed by the tongue or secretions, leading to decreased oxygenation and potential asphyxiation.

Think of the airway as the main highway for oxygen to reach the body. If the highway is blocked during an emergency (like a seizure), nothing else matters until the blockage is cleared. All other actions, like giving medications or assessing vital signs, come after ensuring that the oxygen can flow freely through the highway.

Once the airway is secured, other interventions can follow to manage eclampsia and prevent further complications.

• Position the patient on her side to prevent aspiration and facilitate airway clearance.
• After securing the airway, administer magnesium sulfate intravenously as ordered to control the seizure activity.
• Monitor vital signs, including blood pressure and fetal heart rate, after the seizure has subsided.
• Administer oxygen via face mask to ensure adequate oxygenation, especially if the patient’s respiratory effort is compromised.
• Prepare for potential emergency delivery if the maternal or fetal condition deteriorates.

✘Incorrect answer options:

Administer magnesium sulfate intravenously. While administering magnesium sulfate is a critical step in controlling eclamptic seizures, it is not the first priority. Securing the airway comes before any medication administration to ensure the patient’s safety during the seizure.

Assess blood pressure and fetal heart rate. While it is important to monitor blood pressure and fetal heart rate, these assessments should be done after the patient’s airway is secured and the seizure is under control. The immediate concern during an eclamptic seizure is maintaining airway patency and preventing hypoxia.

Administer oxygen via face mask. Administering oxygen is important to ensure adequate maternal and fetal oxygenation, but this should follow after securing the airway. If the airway is not clear, oxygen administration will not be effective and could lead to further complications.

EXPLANATION

✔Correct answer:

Peripheral vascular disease. Peripheral vascular disease (PVD) is a condition that involves narrowed blood vessels outside of the heart and brain, which can lead to reduced blood flow, particularly to the extremities. This condition is highly relevant when considering the administration of Methergine (methylergonovine) for postpartum hemorrhage. Methergine is an ergot alkaloid that causes vasoconstriction and stimulates uterine muscle contractions, making it effective in controlling postpartum hemorrhage. However, because of its potent vasoconstrictive properties, it can exacerbate conditions like PVD by further reducing blood flow to already compromised areas, leading to severe complications such as ischemia or even gangrene.

Methergine works by binding to smooth muscle receptors in the uterus, promoting sustained contractions that help reduce bleeding after childbirth. However, its systemic vasoconstrictive effects can lead to increased blood pressure and decreased peripheral circulation, which can be particularly dangerous in patients with PVD. This makes it crucial for the nurse to consult the healthcare provider before administering Methergine to patients with a history of PVD.

Think of Methergine as a clamp that tightly closes off a leaking pipe (the bleeding uterus). If there’s another part of the pipe (peripheral vessels) that’s already narrowed or damaged (like in PVD), tightening the clamp can reduce the flow of water (blood) to that area even more, potentially causing serious problems downstream.

Before administering Methergine, it is essential to assess the patient’s medical history for any conditions that may contraindicate its use.

• Consult the healthcare provider immediately if the patient has a history of PVD, hypertension, or other cardiovascular issues.
• Consider alternative medications such as Pitocin (oxytocin), which has less systemic vasoconstrictive effects, if the patient has PVD.
• Monitor vital signs closely, especially blood pressure, and assess for any signs of compromised circulation in patients at risk.
• Educate the patient on the importance of reporting any new symptoms, such as severe leg pain or coldness in the extremities, which may indicate worsening PVD.

✘Incorrect answer options:

Hypothyroidism is not directly related to the vasoconstrictive effects of Methergine or Pitocin. While hypothyroidism requires careful management during pregnancy and postpartum, it does not contraindicate the use of these medications for postpartum hemorrhage.

Hypotension is not a primary concern with the use of Methergine, as this drug more commonly raises blood pressure rather than lowers it. However, hypotension may need to be monitored with Pitocin, but it is not a contraindication that would necessarily prevent its use.

Type 1 diabetes is a chronic condition that affects blood sugar levels, but it is not directly affected by the vasoconstrictive properties of Methergine. However, close monitoring of blood glucose is important, but it does not specifically contraindicate the use of Methergine or Pitocin in the management of postpartum hemorrhage.

EXPLANATION

✔Correct answers:

Elevated blood pressure and Facial edema. Pregnancy-induced hypertension (PIH) can progress to preeclampsia, a condition characterized by elevated blood pressure and proteinuria, often accompanied by other signs and symptoms such as edema, particularly in the face and hands. The presence of these signs should prompt further investigation and close monitoring by the nurse.

Elevated blood pressure (≥140/90 mmHg) is a primary indicator of preeclampsia. It is essential to monitor the patient's blood pressure regularly as preeclampsia is defined by the onset of hypertension after 20 weeks of gestation in a previously normotensive woman. Blood pressure elevations are critical signs that preeclampsia may be developing.

Edema, particularly in the face and hands, is another sign of preeclampsia. This swelling occurs due to endothelial dysfunction, which leads to increased capillary permeability and subsequent fluid retention in the tissues. While edema can be common in pregnancy, facial edema is more concerning and should be assessed carefully in the context of other symptoms of preeclampsia.

Consider preeclampsia as a pressure cooker. Elevated blood pressure is like the pressure gauge rising, and facial edema is like steam escaping from the lid—both are warning signs that the pressure is building up and needs to be managed before it reaches a dangerous level.

Nurses should closely monitor blood pressure, assess for signs of edema, and perform regular urine dipstick tests to detect proteinuria. Educating the patient about the importance of reporting symptoms like sudden swelling, headaches, or visual disturbances is also crucial.

• Monitor blood pressure frequently to detect any elevation that might indicate worsening PIH or the onset of preeclampsia.
• Assess for edema, especially in the face and hands, as this may indicate fluid retention associated with preeclampsia.
• Educate the patient on the signs and symptoms of preeclampsia to ensure early detection and intervention.

✘Incorrect answer options:

Negative urinary protein: A negative urinary protein test is not indicative of preeclampsia; instead, the presence of proteinuria (protein in the urine) is a key diagnostic criterion for preeclampsia. Therefore, a negative result would not support the diagnosis of preeclampsia but would rather suggest the absence of this condition.

Increased respirations: Increased respirations are not a specific sign of preeclampsia. While respiratory changes can occur in pregnancy, they are not typically used as diagnostic criteria for preeclampsia. Respiratory rate may become more relevant in severe cases of preeclampsia where pulmonary edema or other complications arise, but it is not a primary sign to monitor in the early detection of preeclampsia.

EXPLANATION

✔Correct answer:

Signs of bleeding, such as in the gums, presence of petechiae, and purpura. Severe preeclampsia is a serious condition that can lead to several life-threatening complications, including HELLP syndrome (Hemolysis, Elevated Liver enzymes, and Low Platelets). One of the key complications of HELLP syndrome is thrombocytopenia (low platelet count), which can result in abnormal bleeding. Signs of bleeding might include bleeding gums, petechiae (small, pinpoint hemorrhages), and purpura (larger areas of bleeding under the skin). These symptoms indicate a significant reduction in platelet count, which impairs the blood’s ability to clot, leading to an increased risk of hemorrhage.

In severe preeclampsia, endothelial damage, and vasospasm can lead to widespread activation of the coagulation cascade. This can result in the consumption of platelets and clotting factors, manifesting as thrombocytopenia. The reduced platelet count can cause bleeding in various tissues, and spotting these signs early is crucial to prevent severe complications like Disseminated Intravascular Coagulation (DIC), a condition where small blood clots form throughout the bloodstream, reducing the availability of platelets for proper clotting.

Imagine platelets as the emergency repair crew for any "leaks" (bleeding) in the body’s plumbing system (blood vessels). If the crew is too small (low platelet count), the repairs (clotting) take longer or may not happen at all, leading to noticeable leaks (bleeding) in areas like the gums or under the skin.

When monitoring a patient with severe preeclampsia, it is essential to regularly assess for signs of bleeding and other indicators of coagulopathy.

• Check platelet counts frequently to monitor for thrombocytopenia.
• Assess for physical signs of bleeding, including petechiae, purpura, hematuria, or prolonged bleeding from minor injuries.
• Monitor for symptoms of HELLP syndrome, such as right upper quadrant pain, nausea, vomiting, and malaise.
• Prepare for potential interventions, such as platelet transfusion or delivery, if the patient’s condition deteriorates.
• Communicate any abnormal findings immediately to the healthcare provider for prompt management.

✘Incorrect answer options:

Breast enlargement. Breast enlargement is a normal physiological change during pregnancy, particularly in the third trimester, as the body prepares for lactation. It is not related to severe preeclampsia or its complications.

Alternating periods of fetal movement and quietness. Variations in fetal movement are normal, especially as the fetus has sleep and wake cycles. While decreased fetal movement can be a concern, alternating periods of movement and quietness are typical and not specific to severe preeclampsia.

Complaints of feeling warm despite a cool room temperature. Feeling warm in a cool environment can be subjective and may be related to hormonal changes in pregnancy or other benign causes. It is not a specific indicator of severe preeclampsia or its complications.

EXPLANATION

✔Correct answer:

Monitor the patient’s deep tendon reflexes every hour. The primary purpose of IV magnesium sulfate in severe preeclampsia is to prevent seizures (eclampsia) by reducing neuromuscular excitability. Magnesium sulfate has a depressant effect on the central nervous system, which can lead to decreased deep tendon reflexes (DTRs). Monitoring DTRs hourly is crucial because the absence or significant reduction in reflexes may indicate magnesium toxicity, a serious condition that requires prompt intervention. Early detection of diminishing DTRs allows for timely administration of calcium gluconate, the antidote for magnesium toxicity.

Magnesium sulfate works by competing with calcium at neuromuscular junctions, thereby reducing the release of acetylcholine and subsequent muscle contractions. This process decreases the likelihood of seizures but also necessitates close monitoring to prevent magnesium toxicity, which can cause respiratory depression, loss of reflexes, and cardiac arrest.

Think of the body’s reflexes as the “check engine light” in a car. If the light starts to dim or go out completely, it signals that something is wrong with the engine. Similarly, a reduction in DTRs signals that magnesium levels might be too high, potentially leading to toxicity, and it needs immediate attention.

Nurses should regularly assess the patient’s level of consciousness, respiratory rate, and urine output, as these are also indicators of magnesium toxicity. Hourly checks of DTRs, along with close monitoring of vital signs, are essential components of care. In the event of diminished reflexes, the nurse should be prepared to stop the infusion and administer calcium gluconate as ordered.

• Hourly DTR assessment to monitor for early signs of magnesium toxicity.
• Continuous fetal monitoring, as magnesium sulfate can affect fetal heart rate variability.
• Monitor respiratory rate closely, as rates below 12 breaths per minute indicate potential respiratory depression.
• Assess urine output, aiming for at least 30 mL/hr, as adequate renal function is necessary to excrete magnesium.
• Keep calcium gluconate readily available as an antidote for magnesium toxicity.

✘Incorrect answer options:

Encourage the patient to ambulate frequently to improve circulation. Ambulation is not advised for patients with severe preeclampsia, as it can exacerbate the condition. Patients with severe preeclampsia are often placed on bed rest to minimize the risk of complications such as placental abruption, seizures, or preterm labor. Bed rest helps to lower blood pressure and reduce the risk of seizures.

Restrict fluid intake to prevent fluid overload. Fluid management in preeclampsia requires a balanced approach, but severe restriction is not typically recommended. Over-restriction can lead to decreased placental perfusion and oliguria. The focus is more on monitoring intake and output to ensure the patient is not at risk of fluid overload while maintaining adequate hydration.

Administer a calcium supplement to counteract the effects of magnesium. Calcium gluconate is the antidote for magnesium toxicity, but it is not administered prophylactically. It is only given if signs of magnesium toxicity occur, such as loss of deep tendon reflexes, respiratory depression, or cardiac arrest. Routine administration of calcium supplements is not part of the standard management of patients receiving magnesium sulfate.

EXPLANATION

✔Correct answer:

Seizures are prevented. The primary purpose of administering magnesium sulfate in a patient with preeclampsia is to prevent the onset of seizures, which is a critical complication of severe preeclampsia that can lead to eclampsia. Magnesium sulfate is a central nervous system depressant that works by stabilizing neuronal membranes, thereby reducing the risk of seizure activity. The effectiveness of magnesium sulfate therapy is primarily determined by the absence of seizures in the patient.

Preeclampsia can lead to increased central nervous system irritability due to endothelial dysfunction, vasoconstriction, and potential cerebral edema. Magnesium sulfate acts as a neuroprotective agent by reducing neuromuscular transmission and decreasing the risk of seizure occurrence. Therefore, if seizures are prevented, it indicates that the magnesium sulfate therapy is effectively managing the neurological complications of preeclampsia.

Think of magnesium sulfate as a "fire extinguisher" for the brain. The fire (seizure) doesn’t start because the extinguisher (magnesium sulfate) is effectively keeping everything calm and cool.

While monitoring a patient on magnesium sulfate therapy, it is important to ensure that the drug is preventing seizures and that the patient is not experiencing signs of toxicity.

• Monitor deep tendon reflexes (DTRs) regularly; absent or significantly diminished DTRs can indicate magnesium toxicity.
• Assess respiratory rate frequently, as respiratory depression is a sign of magnesium sulfate toxicity.
• Monitor urine output to ensure adequate excretion of magnesium, as reduced output can lead to toxicity.
• Observe for any signs of worsening preeclampsia, such as increasing blood pressure, headache, visual disturbances, or epigastric pain, and report them promptly.
• Have calcium gluconate readily available as an antidote in case of magnesium sulfate toxicity.

✘Incorrect answer options:

Ankle clonus is observed. Ankle clonus is a sign of increased neuromuscular irritability and is associated with worsening preeclampsia. The presence of clonus would indicate that magnesium sulfate is not effective in preventing central nervous system hyperactivity and, thus, not preventing seizures.

Blood pressure decreases. While magnesium sulfate may have a mild effect on lowering blood pressure, it is not primarily used for this purpose. Antihypertensive medications are typically used to manage blood pressure in preeclampsia. Therefore, a decrease in blood pressure is not the primary indicator of magnesium sulfate effectiveness.

Scotomas are present. Scotomas (visual disturbances or blind spots) are symptoms of severe preeclampsia and indicate that the condition may be worsening. The presence of scotomas suggests that neurological symptoms are progressing, not that magnesium sulfate is effective.

EXPLANATION

✔Correct answer:

Respiratory rate of 10 breaths per minute. A respiratory rate of 10 breaths per minute is a key indicator of magnesium sulfate toxicity. Magnesium sulfate is a central nervous system depressant and is used in preeclampsia management to prevent seizures. However, high levels can depress the respiratory center in the brain, leading to a dangerously slow respiratory rate (bradypnea). A respiratory rate below 12 breaths per minute is concerning, and a rate of 10 breaths per minute strongly suggests significant magnesium toxicity.

Magnesium sulfate exerts its effects by blocking neuromuscular transmission, which can lead to muscle relaxation, including the muscles involved in breathing. As magnesium levels increase, it can progressively depress the respiratory center in the medulla oblongata, leading to a decrease in the respiratory rate, which can result in respiratory arrest if not promptly addressed.

Imagine magnesium sulfate as a dimmer switch for the nervous system. At the right setting, it prevents dangerous electrical surges (seizures) without affecting normal function. However, if you turn the dimmer too low, the lights (body functions like breathing) start to go out, indicating toxicity.

When signs of magnesium sulfate toxicity are observed, it is critical to take immediate action to prevent further complications, including respiratory arrest.

• Immediately discontinue the magnesium sulfate infusion.
• Administer calcium gluconate, the antidote for magnesium toxicity, as ordered.
• Monitor vital signs, particularly respiratory rate and oxygen saturation, closely.
• Prepare for possible intubation and mechanical ventilation if respiratory compromise worsens.
• Reassess deep tendon reflexes and other signs of neuromuscular function.

✘Incorrect answer options:

Urine output of 25 mL per hour. Although reduced urine output is concerning in any patient and could contribute to increased magnesium levels due to decreased excretion, this finding alone is not specific to magnesium toxicity. It suggests possible renal impairment, which can lead to magnesium accumulation, but it is not a direct confirmation of toxicity.

Presence of active deep tendon reflexes. Active deep tendon reflexes indicate that magnesium levels have not yet reached toxic levels. One of the early signs of magnesium toxicity is the loss or decrease of deep tendon reflexes, as magnesium acts as a neuromuscular blocker. If reflexes are still present, it is less likely that the patient is experiencing significant magnesium toxicity.

Serum magnesium level of 7 mEq/L. A serum magnesium level of 7 mEq/L is elevated but typically within the therapeutic range for a patient receiving magnesium sulfate for preeclampsia management. The therapeutic range for serum magnesium is generally considered to be 4 to 7 mEq/L for seizure prevention. Toxic effects usually become more apparent as levels exceed 7 mEq/L.

EXPLANATION

✔Correct answer:

Proteinuria of +3 on a urine dipstick test. Proteinuria of +3 on a urine dipstick test is a significant finding that should be reported immediately as it may indicate severe preeclampsia. Severe preeclampsia is diagnosed based on a combination of symptoms, including significantly elevated blood pressure (usually ≥160/110 mm Hg on two occasions at least four hours apart) and heavy proteinuria (≥+3 on a dipstick or >300 mg in a 24-hour urine collection). The presence of high levels of protein in the urine suggests significant kidney involvement, which is a hallmark of severe preeclampsia and indicates that the disease process is affecting renal function.

In preeclampsia, widespread endothelial dysfunction leads to vasoconstriction, reduced perfusion, and increased vascular permeability. This process affects the kidneys, causing protein to leak into the urine (proteinuria). As preeclampsia progresses, the level of proteinuria increases, which is a direct marker of worsening renal involvement and the overall severity of the disease. Severe proteinuria indicates that the condition is progressing and can lead to further complications, including eclampsia, HELLP syndrome, and potential damage to maternal organs.

Think of the kidneys as filters. In a healthy system, only the clean water (urine) passes through, leaving the waste behind. In preeclampsia, the filters start to break down, allowing proteins (that should be kept in the blood) to leak into the urine. When a lot of protein is found in the urine, it’s like finding debris in the filtered water—indicating the filters are seriously compromised.

Nurse interventions should focus on closely monitoring the patient’s condition and preventing complications.

• Report the findings of +3 proteinuria to the healthcare provider immediately for further evaluation and possible adjustment in the treatment plan.
• Monitor the patient's blood pressure regularly to detect any further increases.
• Assess for other signs of severe preeclampsia, such as visual disturbances, severe headaches, and right upper quadrant pain.
• Prepare for potential hospitalization and delivery if the patient’s condition worsens.
• Educate the patient about the signs and symptoms of worsening preeclampsia and the importance of seeking immediate medical attention if they occur.

✘Incorrect answer options:

Mild ankle swelling is common during pregnancy, especially in the third trimester, due to fluid retention and is not necessarily a sign of severe preeclampsia. It becomes more concerning if the swelling is generalized or involves the hands and face.

Blood pressure of 140/90 mm Hg meets the criteria for hypertension but is not, by itself, an indicator of severe preeclampsia. Severe preeclampsia typically involves a blood pressure of ≥160/110 mm Hg. However, blood pressure should continue to be monitored closely.

Occasional headaches relieved by rest are relatively common during pregnancy and can be due to a variety of causes, such as fatigue or tension. Severe preeclampsia is more likely to cause persistent, severe headaches that do not resolve with rest or pain relief.

EXPLANATION

✔Correct answer:

Sudden weight gain and edema in the hands and face. Sudden weight gain and edema in the hands and face are classic symptoms indicating that pregnancy-induced hypertension (PIH) is progressing to preeclampsia. Preeclampsia is a serious condition that can develop after 20 weeks of gestation, characterized by hypertension and proteinuria. The presence of edema, especially in unusual locations like the hands and face (as opposed to just the lower extremities), is a hallmark of worsening preeclampsia. The sudden weight gain is often due to fluid retention caused by endothelial dysfunction, which increases vascular permeability.

In preeclampsia, the body's vascular system is under increased stress due to hypertension, which leads to damage in the endothelium (the lining of blood vessels). This damage allows proteins to leak from the blood vessels into surrounding tissues, causing edema. The fluid shift also contributes to the sudden weight gain. Edema in the hands and face is particularly concerning as it indicates significant fluid retention beyond the normal peripheral edema seen in pregnancy.

Imagine the blood vessels as a garden hose that has developed tiny holes. Normally, water (fluid) flows through the hose (vessels) without leaking. In preeclampsia, however, the hose starts leaking water, leading to puddles (edema) forming in places where they shouldn’t, like the hands and face.

Recognizing early signs of preeclampsia is crucial to prevent complications such as eclampsia, which can include seizures, stroke, or other life-threatening conditions.

• Monitor blood pressure closely and assess for proteinuria using dipstick tests or 24-hour urine collection.
• Educate the patient on recognizing symptoms of preeclampsia, such as headaches, visual disturbances, or upper abdominal pain.
• Recommend bed rest or limited activity as ordered, and monitor the patient’s weight gain and edema regularly.
• Provide emotional support and prepare for potential early delivery if the condition worsens.
• Ensure prompt communication with the healthcare provider if any signs of severe preeclampsia or eclampsia develop.

✘Incorrect answer options:

Elevated fasting blood glucose levels. Elevated fasting blood glucose levels are more indicative of gestational diabetes rather than preeclampsia. While gestational diabetes is a concern in pregnancy, it is not directly related to the progression of PIH to preeclampsia.

Increased fetal movement. Increased fetal movement is generally a sign of fetal well-being. A decrease in fetal movement would be more concerning and might indicate fetal distress. Increased movement is not associated with the progression of PIH to preeclampsia.

Frequent urination and thirst. Frequent urination and thirst are symptoms more commonly associated with diabetes, including gestational diabetes. They are not specific to the progression of PIH to preeclampsia and would not be used as indicators of worsening hypertensive disease in pregnancy.

EXPLANATION

✔Correct answer:

The patient reports a headache and blurred vision. The presence of a headache and blurred vision in a patient with mild preeclampsia is a significant concern, as these symptoms suggest that the condition may be progressing to severe preeclampsia. Severe preeclampsia is characterized by neurological symptoms, including headaches, visual disturbances (such as blurred vision or seeing spots), and other signs that indicate increased central nervous system (CNS) irritability. These symptoms are red flags that require immediate medical attention because they can precede more serious complications like eclampsia (seizures) or stroke.

Preeclampsia is associated with endothelial dysfunction, which leads to vasoconstriction, reduced perfusion to vital organs, and increased vascular permeability. As the condition progresses, the resulting hypertension and fluid shifts can cause cerebral edema, leading to increased intracranial pressure. This can manifest as headaches, visual disturbances, and other neurological symptoms. These symptoms are indicative of significant CNS involvement and warrant urgent evaluation and potential intervention.

Think of the brain as a computer that runs smoothly when everything is working correctly. When there’s a problem with the power supply (blood flow and pressure), the computer might start glitching—showing blurry screens (vision disturbances) or running slower (headaches). These glitches indicate that something is wrong and needs fixing before the system crashes (seizure or stroke).

Nurse Kelly should immediately contact the physician if the patient reports headaches and blurred vision. This is critical to ensure prompt medical intervention and to prevent further complications.

• Advise the patient to rest in a dark, quiet environment to minimize CNS stimulation while waiting for further instructions.
• Monitor the patient’s blood pressure and any other signs of worsening preeclampsia, such as changes in reflexes, epigastric pain, or severe edema.
• Prepare the patient for possible hospital admission for closer monitoring and management if severe preeclampsia is suspected.
• Educate the patient on the importance of promptly reporting any new or worsening symptoms to healthcare providers.

✘Incorrect answer options:

Blood pressure remains at the prenatal baseline. If the patient’s blood pressure is at her prenatal baseline, it suggests that the condition is stable. This would not be a cause for immediate concern regarding worsening preeclampsia.

Urinary output has increased. Increased urinary output is generally a positive sign indicating that the kidneys are functioning well and that fluid balance is being maintained. It does not suggest worsening preeclampsia and might even indicate improvement in the patient’s condition.

Dependent edema has been resolved. Resolution of dependent edema is another positive sign and would not be associated with worsening preeclampsia. Dependent edema is common in pregnancy, and its resolution may indicate improved fluid management or a reduction in systemic vascular resistance.