A 26-year-old pregnant woman, gravida 2, para 1-0-0-1, is 28 weeks pregnant when she experiences bright red, painless vaginal bleeding. On her arrival at the hospital, what would be an expected diagnostic procedure?

Choice A reason: This is not the correct answer, as the pregnant woman does not use glucose at a more rapid rate than the nonpregnant woman. In fact, the pregnant woman has lower fasting glucose levels and higher postprandial glucose levels than the nonpregnant woman. This is because the pregnant woman adapts to the increased fetal demand for glucose by increasing her insulin secretion and decreasing her hepatic glucose production.

Choice B reason: This is the correct answer, as placental hormones are antagonistic to insulin, thus resulting in insulin resistance. Insulin resistance is a condition where the cells do not respond well to insulin and require more insulin to maintain normal glucose levels. Placental hormones, such as human placental lactogen, progesterone, and cortisol, increase the insulin resistance of the maternal tissues, especially in the second and third trimesters of pregnancy. This is to ensure that the fetus has enough glucose supply, as the placenta is not insulin resistant and can transport glucose to the fetus².

Choice C reason: This is not the correct answer, as pancreatic function in the islets of Langerhans is not affected by pregnancy. The islets of Langerhans are clusters of cells in the pancreas that produce hormones, such as insulin and glucagon, that regulate glucose metabolism. Pregnancy does not impair the function of the islets of Langerhans, but rather stimulates them to increase their size and number. This is to compensate for the increased insulin resistance and glucose demand of the pregnancy.

Choice D reason: This is not the correct answer, as the pregnant woman does not increase her dietary intake significantly. The pregnant woman needs to consume adequate calories and nutrients to support the fetal growth and development, but not excessively. The recommended weight gain during pregnancy depends on the pre-pregnancy BMI of the woman, but generally ranges from 11 to 16 kg. The recommended calorie intake during pregnancy is about 300 kcal more than the pre-pregnancy intake, which is equivalent to one extra snack per day.

Choice A reason: An antiemetic such as pyridoxine may be used to control vomiting in women with hyperemesis gravidarum, but it is not the initial treatment. The first priority is to restore fluid and electrolyte balance and prevent dehydration and hypovolemia.

Choice B reason: IV therapy is the initial treatment for women with hyperemesis gravidarum. It helps to correct fluid and electrolyte imbalances, prevent dehydration and hypovolemia, and restore normal blood pressure and urine output. IV fluids may also contain glucose, vitamins, and electrolytes to replenish losses.

Choice C reason: Enteral nutrition may be used to meet nutritional needs in women with hyperemesis gravidarum, but it is not the initial treatment. Enteral nutrition involves feeding through a tube inserted into the stomach or intestine. It may be considered if oral intake is not tolerated or adequate after IV therapy.

Choice D reason: Corticosteroids are not used to treat hyperemesis gravidarum. They are used to reduce inflammation in conditions such as asthma, rheumatoid arthritis, and allergic reactions. They have no effect on nausea and vomiting in pregnancy.