QUESTION
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1. Hawa is a 26-year-old female patient with a history of infertility. She and her partner have been trying to conceive naturally for 2 years. Hawa started taking fertility medication 6 months ago to stimulate follicle development. At 21 years of age, she was diagnosed with pelvic inflammatory disease, which was treated with antibiotics. Her menstrual cycle has been unpredictable over the last 3 months, with sporadic light bleeding. During the last month, she has felt nauseous and experienced diarrhea. Yesterday, she had a sudden onset of abdominal and pelvic pain and heavy vaginal bleeding. She is concerned about the sudden change and sees her gynecologist the following day.
Hawa’s gynecologist is concerned she may be experiencing an ectopic pregnancy. Briefly describe what this means, in your own words.
QUESTION 2
1. There are many risk factors for ectopic pregnancies. Which risk factors does Hawa display?
QUESTION 3
1. Hawa’s physician explains that most ectopic pregnancies are “tubal pregnancies.” What does this mean?
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Fertilization occurred outside the fallopian tube.
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Implantation occurred outside the fallopian tube.
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Implantation occurred within the fallopian tube.
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Both ovaries released an egg into fallopian tube.
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QUESTION 4
1. Why is it concerning for a fertilized egg to implant outside of the uterus?
QUESTION 5
1. If Hawa takes a pregnancy test, it will be negative because ectopic pregnancies do not produce the human chorionic gonadotropin.
True
False
QUESTION 6
1. If Hawa’s pregnancy is allowed to continue, which of the following may occur? (Select all possibilities.)
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Permanent damage to her fallopian tube
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Completion of a full term pregnancy
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Life-threatening blood loss
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Increased likelihood for a successful subsequent pregnancy
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QUESTION 7
1. A transvaginal ultrasound is used to confirm Hawa’s tubal pregnancy. Which of the following statements is true?
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Hawa likely became pregnant 6 months ago and was not aware of the pregnancy until now.
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Hawa’s will be allowed to continue her pregnancy, as long as there is no further vaginal bleeding.
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If Hawa’s pregnancy continues, her life could be at risk.
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Hawa’s pregnancy will likely be treated by total hysterectomy.
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QUESTION 8
1. If Hawa’s pregnancy is determined to be only a few weeks along, which of these treatments would be her best option?
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Injection of methotrexate
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Injection of human chorionic gonadotropin
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Partial hysterectomy
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Dilation and curettage
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QUESTION 9
1. If Hawa’s diagnostic ultrasound estimates that her pregnancy is about 4 weeks along, which of the following is true of the fetus?
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Limb buds are well-developed.
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Heartbeat is present.
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Liver is producing bile.
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Urine is produced.
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QUESTION 10
1. If Hawa’s diagnostic ultrasound estimates that her pregnancy is about 8 weeks along, which of the following is true of the fetus?
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Lungs are fully developed.
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Bones have begun to calcify.
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Limb buds have yet to form.
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Sex is distinguishable.
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QUESTION 11
1. Vanessa is a 32-year-old female who has been trying to conceive for 3 months. She tested positive with an at-home pregnancy test after missing her menstrual cycle last month. She has come into the clinic where you work to confirm her pregnancy and begin her prenatal care. She has many questions about the upcoming months. Imagine you are her nurse and help answer her questions.
“I’ve heard that women often throw up in the first few weeks of pregnancy, but I haven’t felt nauseous at all. Does that mean something is wrong?”
QUESTION 12
1. “I already tested positive with a urine test at home. How is a pregnancy blood test different?”
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Blood tests done in a clinic can be more sensitive and measure the quantity of hCG, whereas urine tests simply indicate if hCG is present.
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Urine tests measure hCG, while blood tests for pregnancy measure estrogen levels.
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Urine tests measure estrogen, while blood tests for pregnancy measure hCG levels.
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Urine tests can be accurate 1 week after a missed period, but blood tests cannot detect hCG levels until 1 month after a missed period.
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QUESTION 13
1. “I’ve lost 2 pounds since ovulation. Is that normal?”
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Slight weight loss in the first trimester is normal and you may not notice any weight gain until the third trimester.
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Weight loss is not normal during pregnancy. You should increase your calorie intake by 500 calories/day.
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Slight weight loss in the first trimester is normal. You should continue to eat healthily and do not begin any new diets.
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You should not be losing weight. We will refer you to our dietician for assistance.
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QUESTION 14
1. “I know that different types of prenatal screenings are possible. Which diseases can we test for with a blood test?”
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The most common prenatal screening tests that use blood draws screen for genetic conditions, Down syndrome, trisomy 18, and neural tube defects.
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All genetic disease screening tests require invasive procedures like an amniocentesis.
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Blood tests can screen for infections of the fetus’ bloodstream.
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Prenatal blood tests screen for the most common childhood disorders, including leukemia.
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QUESTION 15
1. “Do I need to refrain from sex during my pregnancy?”
QUESTION 16
1. “I read online that I should make sure my prenatal vitamins contain folic acid. Why is folic acid so important?”
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Folic acid supports nervous system development and can help prevent brain and spinal cord defects.
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Folic acid support gastrointestinal development and prevents intestinal disorders.
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Folic acid, along with B vitamins, are instrumental in the development of muscle.
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Folic acid is responsible for development of the heart early in pregnancy.
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QUESTION 17
1. “My last period began 8 weeks ago. How big is my baby right now?”
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Assuming you are 8 weeks along, your baby is a little over 1 inch in length and bone and muscles are growing. The fingers and toes are still webbed.
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If your LMP was 8 weeks ago, your gestational age is only 4 weeks, meaning your embryo is still forming its 3 germ layers.
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Assuming you are 8 weeks along, your baby is over 3 inches long and can now create its own urine.
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Assuming you are 8 weeks along, your baby is over 3.5 inches long and can respond to your voice.
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QUESTION 18
1. “When will I feel the baby move?”
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Most women feel the first fetal movements in the first trimester.
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Fetal movements can be felt by the mother as early as 8 weeks.
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Fetal movements can be felt by the mother as early as 13-16 weeks.
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Most women do not feel fetal movements until the third trimester.
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QUESTION 19
1. “My mother and sisters have all had preeclampsia with their pregnancies. What is preeclampsia and does my family history mean I will have it, too?”
QUESTION 20
1. Vanessa wants to know about treatments for preeclampsia. There are many options to treat preeclampsia, depending on how far along the pregnancy is at the time of diagnosis. Which of the following is NOT a treatment option if she is diagnosed with preeclampsia at 20 weeks?
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Antihypertensive medication
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Corticosteroid medication
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Bed rest and/or hospitalization
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Immediate induction and premature delivery
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