A pregnant woman comes to the prenatal clinic for an initial visit. In reviewing her childbearing history, the client indicated that she has delivered premature twins, one full-term baby, and has had no abortions. Which GTPAL should the nurse document in this client's record?

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.

Choice A reason: Vibroacoustic stimulation is a technique that uses sound to stimulate the fetus and elicit a response. It is sometimes used in conjunction with the nonstress test (NST), not the CST. The NST measures the fetal heart rate (FHR) in response to fetal movement, while the CST measures the FHR in response to uterine contractions.

Choice B reason: A negative CST result means that the FHR does not show any late decelerations during at least three contractions in a 10-minute period. Late decelerations are decreases in the FHR that begin after the peak of a contraction and return to the baseline after the contraction ends. They indicate uteroplacental insufficiency, which means that the placenta is not delivering enough oxygen and nutrients to the fetus. A negative CST result is reassuring and suggests that the fetus is well-oxygenated and can tolerate labor².

Choice C reason: The CST is not an invasive test, as it does not involve inserting any instruments or devices into the uterus or the fetus. However, it does require stimulating contractions, either by giving the pregnant woman oxytocin (a hormone that causes uterine contractions) or by having her rub her nipples (which also releases oxytocin). The contractions can be uncomfortable and may trigger preterm labor in some cases.

Choice D reason: The CST is not more effective than the NST if the membranes have already been ruptured. In fact, the CST is contraindicated (not recommended) in women who have ruptured membranes, as it can increase the risk of infection and bleeding. The NST is a safer and simpler alternative to the CST, as it does not require stimulating contractions. However, the NST may not be as reliable as the CST in detecting fetal compromise.