How is purified follicle-stimulating hormone (FSH) (urofollitropin [Metrodin]) administered to an infertile woman as part of the pharmacologic treatment?

Choice A reason: A fetal heartbeat auscultated with a Doppler or a fetoscope is a positive sign of pregnancy, as it confirms the presence of a living fetus in the uterus. A Doppler is an electronic device that uses sound waves to detect the fetal heart rate, while a fetoscope is a stethoscope-like instrument that amplifies the fetal heart sounds. The fetal heartbeat can be heard as early as 10 to 12 weeks of gestation with a Doppler and 18 to 20 weeks of gestation with a fetoscope.

Choice B reason: Quickening is the first perception of fetal movement by the pregnant woman, usually felt between 16 and 20 weeks of gestation for first-time mothers and 13 to 16 weeks of gestation for experienced mothers. However, quickening is not a positive sign of pregnancy, as it can be subjective and mistaken for other sensations, such as gas, hunger, or muscle spasms².

Choice C reason: Morning sickness is a common symptom of pregnancy that involves nausea and vomiting, usually in the first trimester. However, morning sickness is not a positive sign of pregnancy, as it can be caused by other factors, such as food poisoning, stress, or medication.

Choice D reason: A positive pregnancy test is a probable sign of pregnancy, not a positive sign. A pregnancy test detects the presence of human chorionic gonadotropin (hCG), a hormone produced by the placenta, in the urine or blood of the woman. However, a positive pregnancy test does not guarantee a viable pregnancy, as it can be influenced by the timing, the quality, or the interpretation of the test. A positive pregnancy test can also occur in cases of ectopic pregnancy, molar pregnancy, or miscarriage.

Choice A reason: Raising the woman's legs is not the best initial response, as it may worsen the dizziness and light-headedness. This is because raising the legs can increase the blood flow to the lower extremities and decrease the blood flow to the brain, which can cause hypotension (low blood pressure) and hypoxia (low oxygen) in the woman and the fetus.

Choice B reason: Having the woman breathe into a paper bag is not the best initial response, as it may not address the underlying cause of the dizziness and light-headedness. This technique is usually used for hyperventilation (rapid breathing), which can cause respiratory alkalosis (high blood pH) and reduce the carbon dioxide levels in the blood. However, the woman may not be hyperventilating, but rather experiencing supine hypotensive syndrome (low blood pressure when lying on the back) due to the pressure of the uterus on the inferior vena cava (a large vein that returns blood to the heart)².

Choice C reason: Turning the woman on her side is the best initial response, as it can relieve the dizziness and light-headedness by improving the blood flow to the brain and the fetus. This is because turning the woman on her side can reduce the pressure of the uterus on the inferior vena cava and increase the cardiac output (the amount of blood pumped by the heart) and the blood pressure. The left lateral position is preferred, as it can also optimize the placental perfusion (the blood flow to the placenta) and the fetal oxygenation.

Choice D reason: Assessing the woman's blood pressure and pulse is an important response, but not the first one. After turning the woman on her side, the nurse should monitor the vital signs and the fetal heart rate to evaluate the condition of the woman and the fetus. The nurse should also check for other signs and symptoms of supine hypotensive syndrome, such as nausea, sweating, and visual disturbances.