Health Promotion and Maintenance Q 98

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A client tells the doctor that she is about 20 weeks pregnant. The most definitive sign of pregnancy is:

  

     A. Elevated human chorionic gonadotropin

     B. The presence of fetal heart tones

     C. Uterine enlargement

     D. Breast enlargement and tenderness

    

    

Correct Answer: B. The presence of fetal heart tones

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The most definitive diagnosis of pregnancy is the presence of fetal heart tones. The signs in answers A, C, and D are subjective and might be related to other medical conditions. Fetal heart tones can be appreciated between six and eight weeks of gestation. Between eight and ten weeks of gestation, important information about the pregnancy can be obtained by the provider, including placental location, fetal position and anatomy, amniotic fluid volume, and maternal anatomy, including dimensions of the cervix and uterus.

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Option A: It is important to note that an elevated beta-HCG level is not definitive of a normal or viable pregnancy. Conditions that result in elevated beta-HCG levels must be considered, including ectopic and heterotopic pregnancy; miscarriage; and the presence of abnormal germ cell, placental, and embryonal tissues.

Option C: Uterine enlargement may be related to a hydatidiform mole. The list of early pregnancy complications is vast, including ectopic pregnancy, heterotopic pregnancy, molar pregnancy, and miscarriage. The provider needs to visualize an intrauterine pregnancy for reasons discussed in prior sections.

Option D: Breast enlargement and tenderness is often present before menses or with the use of oral contraceptives. Early in pregnancy hormonal changes might make your breasts sensitive and sore. The discomfort will likely decrease after a few weeks as your body adjusts to hormonal changes.

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