Which of the following is a normal finding in the third trimester of pregnancy?

Question

A woman in the first trimester of pregnancy has a history of previous toxoplasmosis and is IgG positive. What is the advice?

Answer 1

Late pregnancy brings several changes to the heart and chest that are perfectly normal, and the question wants us to pick out the true benign one from a set of options.

Apex beat shifted to the 4th intercostal space: The growing uterus pushes the diaphragm up, which tilts and displaces the heart upward and slightly outward. This moves the apex beat, normally felt in the fifth intercostal space, up to the fourth. This is a well recognized, harmless change of late pregnancy.
Cardiomegaly: A truly enlarged heart is never a benign pregnancy finding, it points toward a real cardiac problem such as peripartum cardiomyopathy and calls for further testing.
Diaphragm is pushed up: This does happen due to the enlarging uterus, and it is in fact the mechanical reason behind the apex beat shift, but by itself it is a respiratory-mechanics change rather than the cardiac examination sign the question is aimed at.
Short mid diastolic murmur: Pregnancy can produce a soft systolic flow murmur from the higher cardiac output, but a diastolic murmur is not part of that normal pattern and instead should prompt a look for valve disease such as mitral stenosis.

Among the choices, the apex beat shifting to the fourth intercostal space is the one benign, well described change of the third trimester heart examination.

Let's summarize:

The uterus pushes the diaphragm up, which shifts the heart and moves the apex beat to the fourth intercostal space, a normal finding.
True cardiomegaly and a diastolic murmur are warning signs, not normal pregnancy changes.

So the normal finding of the third trimester is the apex beat shifted to the fourth intercostal space.

Answer 2

Late pregnancy brings several changes to the heart and chest that are perfectly normal, and the question wants us to pick out the true benign one from a set of options.

Apex beat shifted to the 4th intercostal space: The growing uterus pushes the diaphragm up, which tilts and displaces the heart upward and slightly outward. This moves the apex beat, normally felt in the fifth intercostal space, up to the fourth. This is a well recognized, harmless change of late pregnancy.
Cardiomegaly: A truly enlarged heart is never a benign pregnancy finding, it points toward a real cardiac problem such as peripartum cardiomyopathy and calls for further testing.
Diaphragm is pushed up: This does happen due to the enlarging uterus, and it is in fact the mechanical reason behind the apex beat shift, but by itself it is a respiratory-mechanics change rather than the cardiac examination sign the question is aimed at.
Short mid diastolic murmur: Pregnancy can produce a soft systolic flow murmur from the higher cardiac output, but a diastolic murmur is not part of that normal pattern and instead should prompt a look for valve disease such as mitral stenosis.

Among the choices, the apex beat shifting to the fourth intercostal space is the one benign, well described change of the third trimester heart examination.

Let's summarize:

The uterus pushes the diaphragm up, which shifts the heart and moves the apex beat to the fourth intercostal space, a normal finding.
True cardiomegaly and a diastolic murmur are warning signs, not normal pregnancy changes.

So the normal finding of the third trimester is the apex beat shifted to the fourth intercostal space.

Which of the following is a normal finding in the third trimester of pregnancy?

Show Hint

The Correct Option is A

Solution and Explanation

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