A healthy 31-year-old G3P2002 patient presents to the obstetrician’s office at 34 weeks gestational age for a routine return visit. She has had an uneventful pregnancy to date. Her baseline blood pressures were 100-110/ 60-70, and she has gained a total of 20 lb so far. During the visit, the patient complains of bilateral pedal edema that sometimes causes her feet to ache at the end of the day. Her urine dip indicates trace protein, and her blood pressure in the office is currently 115/75. She denies any other symptoms or complaints. On physical exam, there is pitting edema of both legs without any calf tenderness. How should the obstetrician respond to the patient’s concern?

**Core Concept**
Pitting edema in a pregnant woman, particularly in the absence of other symptoms like hypertension or proteinuria, is often a benign condition related to the physiological changes of pregnancy. The increased blood volume and venous pressure lead to fluid accumulation in the lower extremities.

**Why the Correct Answer is Right**
The obstetrician should reassure the patient that her edema is likely a normal finding in pregnancy, related to the increased blood volume and venous pressure. The patient's blood pressure is within a normal range, and the absence of significant proteinuria or other symptoms makes pre-eclampsia less likely. Additionally, the patient's edema is described as pitting, which is a characteristic feature of physiological edema in pregnancy.

**Why Each Wrong Option is Incorrect**
**Option A:** This choice would be incorrect because it implies that the patient has pre-eclampsia, which would require more aggressive management, including regular blood pressure monitoring and possibly corticosteroids for fetal lung maturation. However, the patient's blood pressure is normal, and the edema is not accompanied by other symptoms of pre-eclampsia.
**Option B:** This choice would be incorrect because it fails to address the patient's primary concern, which is the edema and its implications for her pregnancy. A simple reassurance that her edema is normal would be more appropriate.
**Option C:** This choice would be incorrect because it implies that the patient has deep vein thrombosis (DVT), which would require further investigation, including imaging studies. However, the patient's physical exam is negative for calf tenderness, which makes DVT less likely.

**Clinical Pearl / High-Yield Fact**
Physiological edema in pregnancy is a common and benign condition that resolves postpartum. Obstetricians should be able to distinguish it from pathologic conditions like pre-eclampsia, which requires more aggressive management.

**Correct Answer:** B. Reassure the patient that her edema is likely a normal finding in pregnancy, related to the increased blood volume and venous pressure.

✓ Correct Answer: D. Reassure the patient that this is a normal finding of pregnancy, and no treatment is needed