Which of the following are lifestyle modifications recommended for managing heartburn during pregnancy? Select all that apply.

Braxton Hicks contractionsare irregular uterine contractions, generally painless, that do not cause cervical change. They begin as early as the second trimester but are most noticeable in the third trimester. Uterine tone normally increases with pregnancy due to rising estrogen and oxytocin receptor sensitivity, but Braxton Hicks contractions remain non-progressive. They are sometimes referred to as “false labor” because, unlike true labor contractions, they do not lead to cervical effacement or dilation.

Rationale for correct answers

2.Irregular, often painless uterine contractions without cervical dilation or effacement are the hallmark of Braxton Hicks. They usually resolve with rest, hydration, or position change and are not considered true labor.

Rationale for incorrect answers

1.Regular, painful contractions that cause cervical dilation define true labor, not Braxton Hicks. True labor contractions progressively intensify and shorten in interval.

3.Braxton Hicks contractions improve, not worsen, with hydration and rest. Worsening with activity and persistence despite rest indicates true labor.

4.Braxton Hicks are not a sign of true labor. They are preparatory contractions and do not indicate imminent delivery.

Take home points

• Braxton Hicks contractions are irregular, mild, and non-progressive.
• They do not cause cervical dilation or effacement.
• True labor is characterized by regular, painful contractions with progressive cervical change.
• Hydration, rest, or position change relieves Braxton Hicks but not true labor.

Constipation in pregnancyis due to progesterone-induced smooth muscle relaxation, reduced gastrointestinal motility, and increased water absorptionin the colon. Normal bowel frequency is 3 times per day to 3 times per week, with stool water content 70–75%. Constipation is worsened by iron supplements, low fiber intake (normal recommended 25–30 g/day), and dehydration (recommended fluid intake 2–3 L/day). Nursing assessment should focus on bowel habits, diet, and hydration status.

Rationale for correct answers

1.Evaluating bowel frequency and consistency identifies deviations from normal patterns and confirms constipation. Hard, infrequent stools suggest delayed colonic transit.

2.Assessing dietary fiber intake is essential since insufficient fiber reduces stool bulk and increases constipation risk. Recommended intake is 25–30 g/day.

4.Checking hydration status is important because inadequate fluid intake leads to excessive colonic water reabsorption, hardening stools. Adequate hydration softens stool and improves motility.

Rationale for incorrect answers

3.Monitoring respiratory rate is not relevant to constipation assessment. Respiratory changes in pregnancy are related to diaphragm elevation, not bowel habits.

5.Measuring blood glucose levels is related to screening for gestational diabetes, not constipation. Constipation is unrelated to glycemic status.

Take home points

• Constipation in pregnancy is due to progesterone, iron supplements, low fiber, and dehydration.
• Assessment should focus on stool frequency/consistency, fiber intake, and hydration status.
• Adequate hydration (2–3 L/day) and fiber (25–30 g/day) prevent constipation.
• Must differentiate constipation from bowel obstruction, which presents with pain, distension, and vomiting.