Pregnancy Case Study:
Isabella and Christopher are a young couple, ages 26 and 28, who have been married for
two years and have not been using birth control for the past year. They are concerned
and have come to the infertility clinic where you are working as a graduate nurse. You
explain to them that infertility is not uncommon and occurs in 10– 15% of couples.
During the extensive history of both partners you review not only sexual history but
nutrition and exercise.
You need to discuss the menstrual cycle with them so they understand that the chance of
conceiving is increased at the time of ovulation. Isabella’s cycle is 28– 30 days. The
menstrual phase occurs in days 1 through 6 of the cycle.
Please provide education to this couple on the menstrual cycle and when ovulation
occurs.
1. Describe what happens in the ovaries - what hormones are involved?
The ovaries contain the eggs or the ova, which is used for fertilization. This is otherwise known
as the ovarian cycle, where a mature egg is produced . If fertilization does not occur, then it
shifts to the endometrial cycle. The ovarian cycle only occurs when the body realizes it has
been fertilized and preparation for pregnancy has to occur. During the endometrial cycle when
there is no fertilization, the egg attaches to the endometrial wall. The anterior pituitary gland
releases FSH and LH which signals the ovaries to release the egg.
2. Describe what happens in the uterus – what hormones are involved?
The uterine lining begins to thicken to prepare for an egg delivery, or to catch the egg. The egg
is unfertilized, therefore progesterone continues to aid the thickening in the uterine lining. This
process happens during the secretory phase of the endometrial cycle. After this phase, the
menstrual cycle begins where the uterine lining is shed.
3. Describe what happens with ovulation?
, The anterior pituitary gland releases FSH and LH during the ovulation cycle . LH peaks during
this cycle which triggers the release of the egg (ovulation). Estrogen and progesterone help
assist the mature egg down the fallopian tubes. Here, the egg will be fertilized by a mature
sperm cell. A woman may notice that their cervical mucus or discharge will be thin and runny.
This is the bodies way to help the sperm cell locate the egg.
4. Select the other symptoms that indicate a woman is ovulating:
Thick non stretchable vaginal mucus
Decrease in body temperature by 1 ° F
Cervical mucous ferns
Mittelschmerz
TWO months later. Your education was so successful that Isabella and Christopher are
now pregnant!
4. What presumptive signs might Isabella describe that could indicate she is pregnant?
Most common signs are the dismissal of a period, increased urination, and nausea/vomiting.
Other presumptive signs can include uterine growth, hyperpigmentation skin and/or Chadwick's
sign. This is typically identified as a blueish/purple coloring of the vaginal tissue indicating that it
is becoming more vascular.
5. What probable signs might her provider observe that could indicate she is pregnant?
A clear probable sign is a positive at home pregnancy test. Other signs that can be tested for
are increased Chadwick's sign or increased vascularity of the vaginal tissue, the white mucous
plug forming (Goodell’s sign), as well as softening of the lower part of the uterus upon palpation
(Hegers).
6. What positive signs indicate that she IS pregnant?
An ultrasound confirms the pregnancy which would be a positive sign of pregnancy. Also,
auscultating the fetal heart rate and cardiac movements of the fetus is possible within 4 weeks
post amenorrhea. Lastly, she would also be able to observe and feel fetal movement.
7. Discuss teratogens and their effect on fetal development?
Teratogens are harmful toxins to the fetus during fetal development. They can cause birth
defects and abnormalities if the fetus is exposed to them during the first trimester of pregnancy.
8. Discuss the known detrimental effects of the following substances and teach Isabella
to avoid them. The substances are:
Alcohol- associated with risk of miscarriage, still borns, or preterm births. No alcohol should be
consumed during pregnancy, which includes the glass of red wine.
Marijuana- chemicals associated with maijuana mix with the fetal blood causing fetal growth
restriction
Isabella and Christopher are a young couple, ages 26 and 28, who have been married for
two years and have not been using birth control for the past year. They are concerned
and have come to the infertility clinic where you are working as a graduate nurse. You
explain to them that infertility is not uncommon and occurs in 10– 15% of couples.
During the extensive history of both partners you review not only sexual history but
nutrition and exercise.
You need to discuss the menstrual cycle with them so they understand that the chance of
conceiving is increased at the time of ovulation. Isabella’s cycle is 28– 30 days. The
menstrual phase occurs in days 1 through 6 of the cycle.
Please provide education to this couple on the menstrual cycle and when ovulation
occurs.
1. Describe what happens in the ovaries - what hormones are involved?
The ovaries contain the eggs or the ova, which is used for fertilization. This is otherwise known
as the ovarian cycle, where a mature egg is produced . If fertilization does not occur, then it
shifts to the endometrial cycle. The ovarian cycle only occurs when the body realizes it has
been fertilized and preparation for pregnancy has to occur. During the endometrial cycle when
there is no fertilization, the egg attaches to the endometrial wall. The anterior pituitary gland
releases FSH and LH which signals the ovaries to release the egg.
2. Describe what happens in the uterus – what hormones are involved?
The uterine lining begins to thicken to prepare for an egg delivery, or to catch the egg. The egg
is unfertilized, therefore progesterone continues to aid the thickening in the uterine lining. This
process happens during the secretory phase of the endometrial cycle. After this phase, the
menstrual cycle begins where the uterine lining is shed.
3. Describe what happens with ovulation?
, The anterior pituitary gland releases FSH and LH during the ovulation cycle . LH peaks during
this cycle which triggers the release of the egg (ovulation). Estrogen and progesterone help
assist the mature egg down the fallopian tubes. Here, the egg will be fertilized by a mature
sperm cell. A woman may notice that their cervical mucus or discharge will be thin and runny.
This is the bodies way to help the sperm cell locate the egg.
4. Select the other symptoms that indicate a woman is ovulating:
Thick non stretchable vaginal mucus
Decrease in body temperature by 1 ° F
Cervical mucous ferns
Mittelschmerz
TWO months later. Your education was so successful that Isabella and Christopher are
now pregnant!
4. What presumptive signs might Isabella describe that could indicate she is pregnant?
Most common signs are the dismissal of a period, increased urination, and nausea/vomiting.
Other presumptive signs can include uterine growth, hyperpigmentation skin and/or Chadwick's
sign. This is typically identified as a blueish/purple coloring of the vaginal tissue indicating that it
is becoming more vascular.
5. What probable signs might her provider observe that could indicate she is pregnant?
A clear probable sign is a positive at home pregnancy test. Other signs that can be tested for
are increased Chadwick's sign or increased vascularity of the vaginal tissue, the white mucous
plug forming (Goodell’s sign), as well as softening of the lower part of the uterus upon palpation
(Hegers).
6. What positive signs indicate that she IS pregnant?
An ultrasound confirms the pregnancy which would be a positive sign of pregnancy. Also,
auscultating the fetal heart rate and cardiac movements of the fetus is possible within 4 weeks
post amenorrhea. Lastly, she would also be able to observe and feel fetal movement.
7. Discuss teratogens and their effect on fetal development?
Teratogens are harmful toxins to the fetus during fetal development. They can cause birth
defects and abnormalities if the fetus is exposed to them during the first trimester of pregnancy.
8. Discuss the known detrimental effects of the following substances and teach Isabella
to avoid them. The substances are:
Alcohol- associated with risk of miscarriage, still borns, or preterm births. No alcohol should be
consumed during pregnancy, which includes the glass of red wine.
Marijuana- chemicals associated with maijuana mix with the fetal blood causing fetal growth
restriction
