Management of common pregnancy complaints US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Management of common pregnancy complaints. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Management of common pregnancy complaints US Medical PG Question 1: A 29-year-old woman, gravida 1, para 0, at 36 weeks' gestation is brought to the emergency department after an episode of dizziness and vomiting followed by loss of consciousness lasting 1 minute. She reports that her symptoms started after lying down on her back to rest, as she felt tired during yoga class. Her pregnancy has been uncomplicated. On arrival, she is diaphoretic and pale. Her pulse is 115/min and blood pressure is 90/58 mm Hg. On examination, the patient is lying in the supine position with a fundal height of 36 cm. There is a prolonged fetal heart rate deceleration to 80/min. Which of the following is the most appropriate action to reverse this patient's symptoms in the future?
- A. Performing the Muller maneuver
- B. Gentle compression with an abdominal binder
- C. Lying in the supine position and elevating legs
- D. Lying in the left lateral decubitus position (Correct Answer)
- E. Performing the Valsava maneuver
Management of common pregnancy complaints Explanation: ***Lying in the left lateral decubitus position***
- This position relieves **aortocaval compression** by moving the uterus off the **inferior vena cava (IVC)** and aorta.
- Alleviating IVC compression increases **venous return** to the heart, improving **cardiac output** and blood pressure, thereby resolving the patient's symptoms and improving **fetal oxygenation**.
*Performing the Muller maneuver*
- The **Muller maneuver** involves forced inspiration against a closed glottis, creating **negative intrathoracic pressure**.
- This maneuver is used to evaluate **upper airway compromise** and would not address the underlying issue of aortocaval compression.
*Gentle compression with an abdominal binder*
- An **abdominal binder** would apply external pressure to the abdomen, which could worsen rather than alleviate **aortocaval compression**.
- This would further reduce **venous return** and potentially exacerbate the patient's **hypotension** and fetal distress.
*Lying in the supine position and elevating legs*
- Lying in the **supine position** is the cause of the patient's symptoms due to **aortocaval syndrome**.
- While **elevating the legs** can temporarily increase venous return from the legs, it would not relieve the compression of the IVC by the gravid uterus.
*Performing the Valsava maneuver*
- The **Valsalva maneuver** involves forced exhalation against a closed glottis, which increases **intrathoracic pressure** and decreases **venous return**.
- This would further reduce **cardiac output** and worsen the symptoms of **hypotension** and **fetal compromise**.
Management of common pregnancy complaints US Medical PG Question 2: A 35-year-old G3P2 woman currently 39 weeks pregnant presents to the emergency department with painful vaginal bleeding shortly after a motor vehicle accident in which she was a passenger. She had her seat belt on and reports that the airbag deployed immediately upon her car's impact against a tree. She admits that she actively smokes cigarettes. Her prenatal workup is unremarkable. Her previous pregnancies were remarkable for one episode of chorioamnionitis that resolved with antibiotics. Her temperature is 98.6°F (37°C), blood pressure is 90/60 mmHg, pulse is 130/min, and respirations are 20/min. The fetal pulse is 110/min. Her uterus is tender and firm. The remainder of her physical exam is unremarkable. What is the most likely diagnosis?
- A. Placental abruption (Correct Answer)
- B. Eclampsia
- C. Vasa previa
- D. Preterm labor
- E. Preeclampsia
Management of common pregnancy complaints Explanation: ***Placental abruption***
- The patient's presentation with **painful vaginal bleeding** after blunt abdominal trauma (motor vehicle accident), a **tender and firm uterus**, maternal **hypotension** and **tachycardia**, and fetal **bradycardia** is highly characteristic of placental abruption.
- Risk factors like **smoking** and trauma further increase the likelihood of placental abruption.
*Eclampsia*
- Eclampsia is characterized by **new-onset grand mal seizures** in a pregnant woman with preeclampsia, which is not present in this scenario.
- While the patient's low blood pressure and tachycardia are concerning, they do not point to eclampsia.
*Vasa previa*
- Vasa previa involves **fetal blood vessels** running within the fetal membranes over the internal cervical os, risking rupture during labor or membrane rupture, leading to **painless vaginal bleeding** and **fetal distress**.
- The bleeding in this case is described as painful, and the uterine tenderness and firmness are not typical of vasa previa.
*Preterm labor*
- Preterm labor is defined by **regular uterine contractions** causing cervical changes before 37 weeks of gestation, which is not aligned with the patient being 39 weeks pregnant or her symptoms.
- While trauma can initiate labor, the severity of the bleeding and maternal/fetal distress point away from isolated preterm labor.
*Preeclampsia*
- Preeclampsia is characterized by **new-onset hypertension** (blood pressure ≥140/90 mmHg) and **proteinuria** after 20 weeks of gestation.
- This patient presents with hypotension and no mention of hypertension or proteinuria, making preeclampsia unlikely.
Management of common pregnancy complaints US Medical PG Question 3: A 45-year-old woman comes to the physician because of early satiety and intermittent nausea for 3 months. During this period she has also felt uncomfortably full after meals and has vomited occasionally. She has not had retrosternal or epigastric pain. She has longstanding type 1 diabetes mellitus, diabetic nephropathy, and generalized anxiety disorder. Current medications include insulin, ramipril, and escitalopram. Vital signs are within normal limits. Examination shows dry mucous membranes and mild epigastric tenderness. Her hemoglobin A1C concentration was 12.2% 3 weeks ago. Which of the following drugs is most appropriate to treat this patient's current condition?
- A. Ondansetron
- B. Clarithromycin
- C. Calcium carbonate
- D. Metoclopramide (Correct Answer)
- E. Omeprazole
Management of common pregnancy complaints Explanation: ***Metoclopramide***
- This patient presents with symptoms of **gastroparesis**, including early satiety, nausea, vomiting, and postprandial fullness, in the setting of **longstanding type 1 diabetes mellitus** and a very high HbA1c (12.2%), indicative of poor glycemic control.
- **Metoclopramide** is a prokinetic agent that acts as a **dopamine D2 receptor antagonist**. It increases gastric motility and emptying, which is the primary pathology in diabetic gastroparesis, making it the most appropriate treatment.
*Ondansetron*
- Ondansetron is a **serotonin 5-HT3 receptor antagonist** and primarily acts as an antiemetic, reducing nausea and vomiting.
- While it could alleviate some symptoms, it does not address the underlying problem of **delayed gastric emptying** in gastroparesis.
*Clarithromycin*
- Clarithromycin is a **macrolide antibiotic** that can exhibit prokinetic effects due to its action on motilin receptors, but it is typically reserved for cases where metoclopramide is contraindicated or ineffective due to concerns regarding **antibiotic resistance** and potential side effects with prolonged use.
- It is not a first-line treatment for diabetic gastroparesis.
*Calcium carbonate*
- Calcium carbonate is an **antacid** used to neutralize stomach acid, providing relief from heartburn and indigestion.
- It would not be effective in treating the symptoms of gastroparesis, which are related to **impaired gastric motility**, not acid production.
*Omeprazole*
- Omeprazole is a **proton pump inhibitor (PPI)** that reduces stomach acid production by irreversibly binding to the H+/K+-ATPase pump.
- It is used to treat conditions like GERD, peptic ulcers, and esophagitis, which are not suggested by the patient's primary symptoms of **early satiety and nausea without retrosternal pain**.
Management of common pregnancy complaints US Medical PG Question 4: A 25-year-old G1P0 woman at 22 weeks’ gestation presents to the emergency department with persistent vomiting over the past 8 weeks which has resulted in 5.5 kg (12.1 lb) of unintentional weight loss. She has not received any routine prenatal care to this point. She reports having tried diet modification and over-the-counter remedies with no improvement. The patient's blood pressure is 103/75 mm Hg, pulse is 93/min, respiratory rate is 15/min, and temperature is 36.7°C (98.1°F). Physical examination reveals an anxious and fatigued-appearing young woman, but whose findings are otherwise within normal limits. What is the next and most important step in her management?
- A. Begin treatment with vitamin B6
- B. Begin treatment with metoclopramide
- C. Obtain a basic electrolyte panel
- D. Obtain a beta hCG and pelvic ultrasound
- E. Admit and begin intravenous rehydration (Correct Answer)
Management of common pregnancy complaints Explanation: ***Admit and begin intravenous rehydration***
- The patient exhibits signs of **hyperemesis gravidarum**, including persistent vomiting, **significant weight loss** (5.5 kg), and inability to maintain hydration orally.
- **Intravenous rehydration** is crucial to correct dehydration and electrolyte imbalances, which can lead to serious complications if left untreated.
*Begin treatment with vitamin B6*
- While **pyridoxine (vitamin B6)** is a first-line treatment for **mild to moderate nausea and vomiting of pregnancy**, it is insufficient for severe cases involving significant weight loss and dehydration.
- This patient's symptoms are beyond what can be effectively addressed with vitamin B6 alone and require more aggressive management.
*Begin treatment with metoclopramide*
- **Metoclopramide** is an antiemetic that can be used for nausea and vomiting in pregnancy, but it is typically reserved for cases where first-line therapies (like vitamin B6) are ineffective.
- Before starting medication, especially in a severely dehydrated patient, addressing the immediate fluid and electrolyte deficits is paramount.
*Obtain a basic electrolyte panel*
- While obtaining an **electrolyte panel** is an important diagnostic step to assess the degree of electrolyte disturbance, it is not the *most important first step* in management.
- The patient's clinical presentation of persistent vomiting and weight loss clearly indicates the need for immediate intravenous rehydration regardless of initial electrolyte results.
*Obtain a beta hCG and pelvic ultrasound*
- A **beta hCG level** and **pelvic ultrasound** might be indicated later to rule out other causes of hyperemesis, such as **multiple gestation** or **molar pregnancy**.
- However, given the patient's acute symptoms of dehydration and weight loss, immediate stabilization with intravenous fluids takes precedence over diagnostic imaging.
Management of common pregnancy complaints US Medical PG Question 5: A 21-year-old woman comes to the physician because she had a positive pregnancy test at home. For the past 3 weeks, she has had nausea and increased urinary frequency. She also had three episodes of non-bloody vomiting. She attends college and is on the varsity soccer team. She runs 45 minutes daily and lifts weights for strength training for 1 hour three times per week. She also reports that she wants to renew her ski pass for the upcoming winter season. Her vital signs are within normal limits. Physical examination shows no abnormalities. Which of the following is the most appropriate recommendation?
- A. Stop playing soccer, stop strength training, and do not buy a ski pass
- B. Continue playing soccer, stop strength training, and do not buy a ski pass
- C. Stop playing soccer, continue strength training, and buy a ski pass
- D. Stop playing soccer, continue strength training, and do not buy a ski pass (Correct Answer)
- E. Continue playing soccer, continue strength training, and do not buy a ski pass
Management of common pregnancy complaints Explanation: ***Stop playing soccer, continue strength training, and do not buy a ski pass***
- This recommendation balances a **healthy lifestyle** with the **safety concerns** associated with pregnancy, reducing exposure to high-impact activities while encouraging beneficial exercises.
- **Soccer** and **skiing** pose risks of falls and abdominal trauma, which are best avoided during pregnancy, while **strength training** can be safely modified.
*Stop playing soccer, stop strength training, and do not buy a ski pass*
- While stopping soccer and skiing is appropriate, completely stopping **strength training** may be overly restrictive, as moderate exercise is generally encouraged in pregnancy.
- Maintaining some level of physical activity, such as **modified strength training**, can help manage weight, improve mood, and prepare the body for labor.
*Continue playing soccer, stop strength training, and do not buy a ski pass*
- **Continuing soccer** is not recommended due to the **high risk of falls** and **abdominal trauma**, which could harm the fetus.
- While stopping skiing is appropriate, discouraging all forms of strength training might remove **beneficial exercise** from her routine.
*Stop playing soccer, continue strength training, and buy a ski pass*
- **Buying a ski pass** and potentially skiing is **contraindicated** due to the high risk of falls and injury, which could endanger the pregnancy.
- Although stopping soccer and continuing strength training are appropriate, the inclusion of skiing makes this an **unsafe recommendation**.
*Continue playing soccer, continue strength training, and do not buy a ski pass*
- **Continuing soccer** is unsafe during pregnancy due to the significant risk of falls, collisions, and **abdominal injury**.
- While strength training can be safely continued with modifications, the inclusion of soccer makes this recommendation **inappropriate**.
Management of common pregnancy complaints US Medical PG Question 6: A 34-year-old woman, gravida 3, para 2, at 16 weeks' gestation comes to the physician because of nausea and recurrent burning epigastric discomfort for 1 month. Her symptoms are worse after heavy meals. She does not smoke or drink alcohol. Examination shows a uterus consistent in size with a 16-week gestation. Palpation of the abdomen elicits mild epigastric tenderness. The physician prescribes her medication to alleviate her symptoms. Treatment with which of the following drugs should be avoided in this patient?
- A. Magnesium hydroxide
- B. Sucralfate
- C. Pantoprazole
- D. Cimetidine
- E. Misoprostol (Correct Answer)
Management of common pregnancy complaints Explanation: ***Misoprostol***
- **Misoprostol** is a prostaglandin E1 analog that stimulates uterine contractions, which can lead to **miscarriage** or **preterm labor**.
- Its **abortifacient properties** contraindicate its use in pregnancy, particularly for symptoms like heartburn.
*Magnesium hydroxide*
- **Magnesium hydroxide** is a common **antacid** that is generally considered safe for occasional use during pregnancy to relieve heartburn.
- While excessive doses can lead to **diarrhea**, it is not contraindicated and does not pose a direct threat to fetal development or pregnancy maintenance.
*Sucralfate*
- **Sucralfate** forms a protective barrier over ulcers and erosions in the GI tract and is minimally absorbed systemically, making it a safe option in pregnancy.
- It works locally and has no known teratogenic effects, often used for **gastric protection** during gestation.
*Pantoprazole*
- **Pantoprazole** is a **proton pump inhibitor (PPI)** that reduces stomach acid production and is generally considered safe for use in pregnancy when indicated for GERD or severe heartburn.
- It is classified as pregnancy category B or C, but extensive observational data have not shown an increased risk of malformations.
*Cimetidine*
- **Cimetidine** is an **H2 receptor antagonist** that decreases gastric acid secretion and is generally considered safe for use in pregnancy to treat heartburn or GERD.
- It is classified as pregnancy category B, and its use is well-established with no significant adverse fetal outcomes reported.
Management of common pregnancy complaints US Medical PG Question 7: A 7-week-old male presents to the pediatrician for vomiting. His parents report that three weeks ago the patient began vomiting after meals. They say that the vomitus appears to be normal stomach contents without streaks of red or green. His parents have already tried repositioning him during mealtimes and switching his formula to eliminate cow’s milk and soy. Despite these adjustments, the vomiting has become more frequent and forceful. The patient’s mother reports that he is voiding about four times per day and that his urine looks dark yellow. The patient has fallen one standard deviation off his growth curve. The patient's mother reports that the pregnancy was uncomplicated other than an episode of sinusitis in the third trimester, for which she was treated with azithromycin. In the office, the patient's temperature is 98.7°F (37.1°C), blood pressure is 58/41 mmHg, pulse is 166/min, and respirations are 16/min. On physical exam, the patient looks small for his age. His abdomen is soft, non-tender, and non-distended.
Which of the following is the best next step in management?
- A. MRI of the head
- B. Intravenous hydration (Correct Answer)
- C. Pyloromyotomy
- D. Thickening feeds
- E. Abdominal ultrasound
Management of common pregnancy complaints Explanation: ***Intravenous hydration***
- The patient exhibits signs of **dehydration** (dark yellow urine, decreased voiding, tachycardia, hypotension) and poor growth, necessitating immediate intravenous fluid resuscitation.
- This step is critical for stabilizing the patient before further diagnostic tests or definitive treatment for the underlying cause of vomiting.
*MRI of the head*
- While vomiting can be a sign of neurological issues, there are no other symptoms suggestive of increased **intracranial pressure** such as lethargy, seizures, or bulging fontanelles.
- Head imaging is not the immediate priority given the prominent signs of dehydration and lack of neurological red flags.
*Pyloromyotomy*
- This is the **definitive surgical treatment** for **pyloric stenosis**, which is a suspected diagnosis given the forceful, non-bilious vomiting and age.
- However, the patient's dehydration and electrolyte imbalances must be corrected *before* surgery to minimize surgical risks.
*Thickening feeds*
- Thickening feeds is commonly used for **gastroesophageal reflux**, but the patient's vomiting is described as "forceful" and increasing in frequency, which is more characteristic of an **obstructive** process rather than simple reflux.
- This intervention is unlikely to resolve the symptoms and does not address the immediate concern of dehydration.
*Abdominal ultrasound*
- An **abdominal ultrasound** is the diagnostic test of choice for **pyloric stenosis**, which is highly suspected given the patient's presentation of progressive, forceful, non-bilious vomiting in an infant.
- While essential for diagnosis, addressing the patient's immediate and life-threatening dehydration takes precedence over imaging.
Management of common pregnancy complaints US Medical PG Question 8: A 29-year-old woman presents to a medical office complaining of fatigue, nausea, and vomiting for 1 week. Recently, the smell of certain foods makes her nauseous. Her symptoms are more pronounced in the mornings. The emesis is clear-to-yellow without blood. She has had no recent travel out of the country. The medical history is significant for peptic ulcer, for which she takes pantoprazole. The blood pressure is 100/60 mm Hg, the pulse is 70/min, and the respiratory rate is 12/min. The physical examination reveals pale mucosa and conjunctiva, and bilateral breast tenderness. The LMP was 9 weeks ago. What is the most appropriate next step in the management of this patient?
- A. Beta-HCG levels and a transvaginal ultrasound (Correct Answer)
- B. Beta-HCG levels and a transabdominal ultrasound
- C. Beta-HCG levels and a pelvic CT
- D. Abdominal x-ray
- E. Abdominal CT with contrast
Management of common pregnancy complaints Explanation: ***Beta-HCG levels and a transvaginal ultrasound***
- The patient's symptoms (fatigue, nausea, vomiting, morning sickness, breast tenderness, and **amenorrhea** for 9 weeks) strongly suggest **early pregnancy**.
- **Urine or serum beta-HCG** confirms pregnancy, and a **transvaginal ultrasound** is crucial for confirming an **intrauterine pregnancy**, estimating gestational age, and ruling out complications like ectopic pregnancy, especially at this early stage when transabdominal ultrasound might not provide clear images.
*Beta-HCG levels and a transabdominal ultrasound*
- While beta-HCG levels are appropriate, a **transabdominal ultrasound** may not be sufficient to visualize an early intrauterine pregnancy at 9 weeks due to limited resolution compared to transvaginal ultrasound.
- A definitive confirmation of **intrauterine pregnancy** is critical to rule out an **ectopic pregnancy**, which is better achieved with transvaginal imaging in early gestation.
*Beta-HCG levels and a pelvic CT*
- **CT scans** expose the patient to significant **ionizing radiation**, which is **contraindicated in pregnancy** unless absolutely necessary for life-threatening conditions.
- While it could identify some pelvic pathologies, it is **not the primary imaging modality** for confirming or evaluating early pregnancy due to radiation risks and inferior soft tissue resolution for early gestational sacs compared to ultrasound.
*Abdominal x-ray*
- An **abdominal X-ray** involves **ionizing radiation** and offers very limited diagnostic value for early pregnancy, as it cannot visualize the gestational sac, fetus, or fetal heart activity.
- It is **contraindicated** in suspected pregnancy due to the risk of fetal harm.
*Abdominal CT with contrast*
- **Abdominal CT with contrast** involves both **ionizing radiation** and **contrast agents**, both of which pose significant risks to a developing fetus.
- It is an **inappropriate initial step** for suspected pregnancy and offers no specific diagnostic benefits for confirming or characterizing early gestation.
Management of common pregnancy complaints US Medical PG Question 9: A 23-year-old nulligravida presents for evaluation 5 weeks after her last menstrual period. Her previous menstruation cycle was regular, and her medical history is benign. She is sexually active with one partner and does not use contraception. A urine dipstick pregnancy test is negative. The vital signs are as follows: blood pressure 120/80 mm Hg, heart rate 71/min, respiratory rate 13/min, and temperature 36.8°C (98.2°F). The physical examination is notable for breast engorgement, increased pigmentation of the nipples, and linea nigra. The gynecologic examination demonstrates cervical and vaginal cyanosis.
Measurement of which of the following substances is most appropriate in this case?
- A. Blood estriol
- B. Blood human chorionic gonadotropin (Correct Answer)
- C. Urinary estrogen metabolites
- D. Urinary human chorionic gonadotropin
- E. Blood progesterone
Management of common pregnancy complaints Explanation: ***Blood human chorionic gonadotropin***
- The patient exhibits classic signs of early pregnancy, including **breast engorgement**, **nipple hyperpigmentation**, **linea nigra**, and **cervical and vaginal cyanosis** (Chadwick's sign). These signs, combined with a missed menstrual period and unprotected intercourse, strongly indicate pregnancy despite the negative urine dipstick.
- A **blood human chorionic gonadotropin (hCG)** test is more sensitive than a urine test, detecting lower levels of hCG earlier in pregnancy, and is therefore the most appropriate next step to confirm pregnancy.
*Blood estriol*
- **Estriol** levels are used to assess fetal well-being in the late second and third trimesters, typically as part of the **triple or quadruple screen**, not for early pregnancy detection.
- Its levels become significantly elevated much later in pregnancy, making it unsuitable for confirming a pregnancy at 5 weeks.
*Urinary estrogen metabolites*
- **Urinary estrogen metabolites** are primarily used to assess ovarian function and fertility, or to monitor hormone replacement therapy.
- They are not a reliable or standard method for the early detection or confirmation of pregnancy.
*Urinary human chorionic gonadotropin*
- While **urinary hCG** is used for pregnancy detection (e.g., home pregnancy tests), a negative result at 5 weeks, especially in the presence of strong clinical signs of pregnancy, suggests that the levels might be below the detection threshold of the urine test.
- A **quantitative blood hCG** test is superior in sensitivity and can detect very low levels of hCG, confirming or ruling out early pregnancy more definitively.
*Blood progesterone*
- **Progesterone** levels are necessary to maintain a pregnancy, but they do not confirm a pregnancy itself. High progesterone can indicate ovulation and potential luteal phase support.
- While useful for assessing the viability of a confirmed early pregnancy or diagnosing conditions like ectopic pregnancy, it's not the primary test to confirm the presence of pregnancy.
Management of common pregnancy complaints US Medical PG Question 10: A 32-year-old primigravida at 35 weeks gestation seeks evaluation at the emergency department for swelling and redness of the left calf, which started 2 hours ago. She reports that the pain has worsened since the onset. The patient denies a history of insect bites or trauma. She has never experienced something like this in the past. Her pregnancy has been uneventful so far. She does not use alcohol, tobacco, or any illicit drugs. She does not take any medications other than prenatal vitamins. Her temperature is 36.8℃ (98.2℉), the blood pressure is 105/60 mm Hg, the pulse is 110/min, and the respirations are 15/min. The left calf is edematous with the presence of erythema. The skin feels warm and pain is elicited with passive dorsiflexion of the foot. The femoral, popliteal, and pedal pulses are palpable bilaterally. An abdominal examination reveals a fundal height consistent with the gestational age. The lungs are clear to auscultation bilaterally. The patient is admitted to the hospital and appropriate treatment is initiated. Which of the following hormones is most likely implicated in the development of this patient’s condition?
- A. Human placental lactogen
- B. Human chorionic gonadotropin
- C. Progesterone (Correct Answer)
- D. Prolactin
- E. Estriol
Management of common pregnancy complaints Explanation: ***Progesterone***
- This patient presents with symptoms highly suggestive of **deep vein thrombosis (DVT)**, including unilateral leg swelling, warmth, erythema, and pain with dorsiflexion (**Homans' sign**). Pregnancy is a significant risk factor for DVT due to a **hypercoagulable state**.
- **Progesterone** is a key hormone in pregnancy that contributes to venous stasis by causing **venodilation** and decreasing vascular tone, making pregnant women more susceptible to DVT. It also contributes to the overall hypercoagulable state.
*Human placental lactogen*
- **Human placental lactogen (hPL)** is primarily involved in **insulin resistance** and glucose regulation in the mother to ensure nutrient supply to the fetus.
- It does not directly contribute to the thrombotic risk or venous changes seen in DVT.
*Human chorionic gonadotropin*
- **Human chorionic gonadotropin (hCG)** maintains the **corpus luteum** in early pregnancy and is associated with morning sickness.
- While essential for pregnancy, it does not directly influence coagulation or venous status to predispose to DVT.
*Prolactin*
- **Prolactin** is crucial for **mammary gland development** and **lactation**.
- It does not have a direct role in the physiological changes that increase DVT risk during pregnancy.
*Estriol*
- **Estriol** is a major estrogen in pregnancy, and like other estrogens, it contributes to the **hypercoagulable state** by increasing clotting factors and decreasing natural anticoagulants.
- However, progesterone's role in **venodilation and venous stasis** is more directly implicated in the acute development of DVT symptoms in the lower extremities during late pregnancy than the broad procoagulant effects of estrogen.
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