Chapter 12: Nursing Management During Pregnancy
Varicosities of the rectum, or ________, result from progesterone-induced vasodilation and the pressure of the enlarging uterus.
hemorrhoids
A nurse is caring for a pregnant client in her second trimester of pregnancy. The nurse educates the client to look for which danger sign of pregnancy needing immediate attention by the primary care provider?
vaginal bleeding
A client in her second trimester of pregnancy visits a health care facility. The client frequently engages in aerobic exercise and asks the nurse about doing so during her pregnancy. Which precaution should the nurse instruct the pregnant client to take when practicing aerobic exercises?
Maintain tolerable intensity of exercise.
Food allergies are ________ likely to develop in a breast-fed baby.
less
A client at 32 weeks' gestation is admitted to labor and delivery with vaginal bleeding and contractions. The physician orders a course of two steroid injections. The client asks why she needs steroids. What is the best explanation by the nurse?
The steroids speed up the development of the lungs.
Before beginning the initial prenatal examination, a nurse should instruct a client to complete what procedure before undressing?
clean-catch urine
At 12 weeks' gestation, the uterine fundus can be palpated at the umbilicus.
false
A nurse is educating a pregnant client about physical changes that can occur in pregnancy. Which conditions are associated with physical changes in pregnancy? Select all that apply.
nasal stuffiness and sinus problems thoracic breathing instead of abdominal breathing swollen and tender gums
A common report during pregnancy is heartburn. What should the nurse recommend to decrease the discomfort of heartburn?
Eat small, frequent meals.
The __________ method of preparing for labor involves the use of specific breathing and relaxation techniques.
lamaze
The nurse is assessing a client's risk for sexually transmitted infections. Which statement by the client would be cause for concern?
"I am unsure who the father of the baby is. I will be raising it alone."
A woman is in her early second trimester of pregnancy. The nurse would instruct the woman to return for a follow-up visit every:
4 weeks.
A client in the third trimester of pregnancy has to travel a long distance by car. The client is anxious about the effect the travel may have on her pregnancy. Which instruction should the nurse provide to promote easy and safe travel for the client?
Always wear a three-point seat belt.
The nurse is caring for a client who is having a high-risk pregnancy and requires genetic studies. Which procedures will the nurse anticipate? Select all that apply.
Amniocentesis Chorionic villus sampling Percutaneous umbilical blood sampling
A 41-year-old pregnant woman and her husband are anxiously awaiting the results of various blood tests to evaluate the fetus for potential Down syndrome, neural tube defects, and spina bifida. Client education should include which information?
Further testing will be required to confirm any diagnosis.
A pregnant client is planning a vacation to a different state and questions the nurse concerning precautions. Which suggestion should the nurse prioritize for this client who will be traveling by automobile?
Stop and walk every 2 hours.
Nagele's rule to determine the expected date of birth is inaccurate for women with irregular menstrual cycles.
True
A pregnant woman who has come to the clinic for an evaluation is scheduled to undergo nuchal translucency screening. The woman asks the nurse, "What is this test all about?" Which response(s) by the nurse would be appropriate? Select all that apply.
You will have an ultrasound done to check for chromosomal problems." "The provider will check the amount of fluid in the space behind your fetus's neck."
A woman in her second trimester of pregnancy is beginning to experience more headaches. In addition to suggesting holding an ice pack to the forehead, the health care provider recommends which medication to provide some relief from the pain?
acetaminophen
A nurse is providing education to a client who is 8 weeks' pregnant. The client stated she does not like milk. What is a source of calcium that the nurse can recommend to the client?
dark, leafy green vegetables
Why is the first prenatal visit usually the longest prenatal visit?
Baseline data is collected. The first prenatal visit is usually the longest because the baseline data to which all subsequent assessments are compared are obtained at this visit.
The nurse is reinforcing health care provider education on the technique for an amniocentesis. Which piece of equipment will the nurse have ready?
Ultrasound equipment
What anatomic area should be examined when assessing Montgomery glands (Montgomery tubercles)?
breasts Montgomery glands (Montgomery tubercles) are sebaceous glands on the areola of the breasts and are prominent during pregnancy.
While assessing a client's breast during the third trimester, which finding would the nurse expect?
colostrum from the nipples
A pregnant woman has been diagnosed with pica since she eats lead paint chips for their sweetness. The nurse educating this woman should strongly encourage her to abandon this practice because it may have which consequence to the fetus?
neurological challenges
The nurse is preparing to administer a prescribed medication to the pregnant client. Which order should the nurse question?
rubella Most vaccines are contraindicated during pregnancy and are considered teratogenic, such as rubella. Penicillin and acetaminophen may be taken under provider supervision. Folic acid supplementation should be encouraged.
The nurse will be assisting a client during an amniocentesis. Which nursing intervention should the nurse prioritize?
Be certain she is aware of potential complications. The client should be aware of the potential complications and risks, and should sign an informed consent. Opioids are contraindicated for pregnant woman due to side effects. She should maintain bed rest for the remainder of the day, with light housework the following day and a return to normal activities on the third day. It may take 2 or 3 weeks before the test results come back from the laboratory.
A pregnant client wishes to know if sexual intercourse would be safe during her pregnancy. Which should the nurse confirm before educating the client regarding sexual behavior during pregnancy?
Client does not have cervical insufficiency.
The client states that the first day of her last menstrual period is March 23. The nurse is most correct to calculate using Naegele rule that the estimated date of delivery is:
December 30
A client in the first trimester reports having nausea and vomiting, especially in the morning. Which instruction would be most appropriate to help prevent or reduce the client's compliant?
Eat dry crackers or toast before rising. The nurse should recommend the client eat dry crackers or toast before rising to prevent nausea and vomiting in the morning. Drinking plenty of fluids at bedtime could cause nocturia. Foods such as cheese should be avoided to prevent constipation. Spicy foods could cause heartburn.
A pregnant woman comes to the clinic for a prenatal visit for her third pregnancy. She reveals she had a previous miscarriage at 12 weeks and her 3-year-old son was born at 32 weeks. How should the nurse document this woman's obstetric history?
G3, T0, P1, A1, L1 The woman's obstetric history would be documented as G3, T0, P1, A1, L1. G (gravida) = 3 (past and current pregnancy), T (term pregnancies) = 0, P (number of preterm pregnancies) = 1, A (number of pregnancies ending before 20 weeks viability to include miscarriage) = 1, and L (number of living children) = 1.
As part of the first prenatal visit, the nurse is assessing a pregnant woman's obstetrical history, which includes an 18-month-old daughter, born 2 days after her estimated date of birth; a 3-year-old son born at 35 weeks' gestation; and two lost pregnancies, one at 12 weeks and one at 21 weeks. How should the nurse document this history?
G5 T1 P2 A1 L2
The nurse is documenting a non-pregnant client's obstetric history. The client informed the nurse she has 4 children living at home. She birthed one child at 34 weeks' gestation, one child at 37 weeks' gestation, one at 38 weeks' gestation, and one at 39 weeks' gestation. The client has had one abortion. Using the GTPAL format, how will the nurse document the client's obstetric history?
G5, T2, P2, A1, L4 "G" stands for gravida, the total number of pregnancies (5). "T" stands for term, the number of pregnancies that ended at term (at or beyond 38 weeks' gestation)(2). "P" is for preterm, the number of pregnancies that ended after 20 weeks' gestation (2). "A" is for abortions, either spontaneous or elective (1). "L" is for living, the number of children delivered who are alive at the time of history collection (4).
A woman who is 4 months pregnant notices frequent heart palpitations and leg cramps. She is anxious to learn how to alleviate these. Which nursing diagnosis would best apply to her?
Health-seeking behaviors related to ways to relieve discomforts of pregnancy
Which medical pair is the highest concern if reported during a pregnant client's medical history?
Heart disease and diabetes
After teaching a pregnant woman how to perform fetal movement (kick) counts, the nurse determines that the teaching was successful when the client makes which statement?
I'll sit comfortably in a recliner or lie on my side when I do the counts.
A woman has heard that hypotension can be a problem during pregnancy, but she is not sure what it is or what causes it. The nurse explains that it is simply a temporary bout of low blood pressure due to impaired blood return to the heart. It is commonly caused by sleeping in a position that causes compression of the vena cava blood vessel. To avoid this condition, which suggestion should the nurse make?
Sleep on your side.
The health care provider has prescribed an over-the-counter antacid for a pregnant client in her first trimester who is having ongoing nausea, vomiting, and heartburn. Which instruction concerning the antacid should the nurse prioritize after noting the client is also prescribed a multivitamin supplement?
Take antacid 1 hour after the multivitamin. Antacids interfere with the uptake of the vitamin contents so the client should take the antacid 1 hour after taking the multivitamin. Caffeine should be avoided due to increases in blood pressure and diuretic effects. Antacids can be taken more often than solely at bedtime, and some clients need them after each meal. Antacids do not have to be taken with dairy products. The priority is to avoid allowing the antacid to cancel out the multivitamin.
A pregnant client is undergoing a fetal biophysical profile. Which parameter of the profile helps measure long-term adequacy of the placental function?
amniotic fluid volume
Which disease process would the nurse screen for under potential genetic disorders?
cystic fibrosis
When preparing a class for a group of pregnant women about nicotine use during pregnancy, the nurse describes the major risks associated with nicotine use, including:
decreased birth weight in neonates. The nurse should inform the client that children born of mothers who use nicotine will have a decreased birth weight. Spontaneous abortion (miscarriage) is associated with caffeine use. Increased risks of stillbirth and placental abruption (abruptio placentae) are associated with mothers addicted to cocaine.
A nurse assesses a 32-year-old primigravida client with twin gestation in her second trimester. The client reports constipation from iron supplements. Which condition should the nurse assess for in this client as a result of the constipation?
hemorrhoids
What is the term that refers to a woman who has never been pregnant?
nulligravida Gravida refers to the number of pregnancies the woman has had (regardless of the outcome). For example, a woman who has had one pregnancy is a gravida 1, whereas a woman who has had five pregnancies is a gravida 5. A woman who has never been pregnant is a nulligravida, whereas a woman who has had more than one pregnancy is a multigravida.
Which occupation may expose a fetus to environmental hazards? Select all that apply.
nurse anesthetist working in a busy oral surgeon's office short-order cook for a busy deli nurse working for a pulmonologist who administers inhalation ribavirin routinely to the client
A pregnant client reports difficulty sleeping well. Which suggestion for sleeping should the nurse prioritize to assist this client?
on her side with the weight of the uterus on the bed
A young woman with scoliosis has just learned that she is pregnant. Several years ago, she had stainless-steel rods surgically implanted on both sides of her vertebrae to strengthen and straighten her spine. However, her pelvis is unaffected by the condition. What does the nurse anticipate in this woman's pregnancy?
potential for greater than usual back pain
The nurse is assessing a primipara's fundal height at 36 weeks' gestation and notes the fundus is now located at the xiphoid process of the sternum. The client asks if this is normal. Which response to the client would be best?
"At 36 weeks' gestation, the fundus is in the normal expected location."
After teaching the pregnant woman about ways to minimize flatulence and bloating during pregnancy, the nurse understands that which client statement indicates the need for additional teaching?
"I'll switch to chewing gum instead of using mints."
The nurse is assessing a client at her first prenatal visit and notes that she is exposed to various chemicals at her place of employment. Which statement by the client would indicate she needs additional health education to protect her and her fetus?
"The gloves they provide irritate my hands, so I don't use them."
A gravida woman in her second trimester has shared that she still enjoys a glass of wine about once a week with dinner. What response by the nurse is most appropriate?
"There is no amount of alcohol consumption in pregnancy that is considered safe for the fetus."
A young couple are very excited to discover they are pregnant and ask the nurse when to expect the baby. Based on a July 20 LMP, which day will the nurse predict for delivery?
April 27
What is the most effective way for a nurse to assess a woman's usual food intake during her pregnancy?
Ask her to describe her intake for the last 24 hours.
A woman has come to the clinic for her first prenatal visit. Which method would be the most effective way for the nurse to initiate data gathering for a health history?
Conduct an interview in a private room to obtain her health history.
Why is a Papanicolaou test done at the first prenatal visit?
It identifies abnormal cervical cells. A Pap test is a test for cervical cancer. Should abnormal cells be present, the woman may need to make a decision about her priorities of therapy for cervical disease or continuing the pregnancy.
The optimal time for alpha-fetoprotein screening is 16 to 18 weeks of gestation.
TRUE
The health care provider has prescribed an over-the-counter antacid for a pregnant client in her first trimester who is having ongoing nausea, vomiting, and heartburn. Which instruction concerning the antacid should the nurse prioritize after noting the client is also prescribed a multivitamin supplement?
Take antacid 1 hour after the multivitamin.
The client is 32 weeks' pregnant and has been referred for a biophysical profile (BPP) after a nonreassuring nonstress test (NST). Which statement made by the client indicates that the nurse's explanation of the procedure was effective?
The BPP is an ultrasound that measures breathing, body movement, tone, and amniotic fluid volume.
During the initial assessment of a 22-year-old pregnant client, the nurse learns that the client usually smokes 2 packs of cigarettes per day. The nurse is planning an education session about lifestyle changes during pregnancy. Which goal would be the most realistic and individualized for this client during this initial clinic visit?
The client reduces her smoking by 50 percent by the next clinic visit
A client in her third trimester reports to the nurse shortness of breath when sleeping. The nurse informs the client that this is normal and occurs because the growing fetus puts pressure on the diaphragm. Which measure should the nurse suggest to help alleviate this problem?
Use extra pillows. The nurse should instruct the client to use extra pillows at night to keep her more upright. The nurse can instruct the client to use a firmer mattress if the client is experiencing backache. The nurse can ask the client to avoid overeating and ingesting spicy food in case the client is experiencing heartburn.
The nurse teaches a sedentary pregnant client with a BMI of 35 about the importance of healthy lifestyle during pregnancy. Which goal would be appropriate for this client?
Walk for 30 minutes 5 days a week. For a sedentary client a walking program is an appropriate goal. Dieting/weight reduction is never recommended during pregnancy. A daily aerobic or weight lifting program are not appropriate goals for a sedentary client with a high BMI.
A 31-year-old client at 28 weeks' gestation reports frequent low back pain and ankle edema by the end of the day. Which suggestion should the nurse prioritize for this client?
Rest when possible with feet elevated at or above the heart.
Increased vaginal discharge during the first trimester is a normal finding.
True
An adolescent at 8 weeks' gestation is at her first prenatal visit. During the health history interview, the nurse asks the client, "Are you afraid of anyone?" What is the nurse assessing with this question?
intimate partner violence
A woman is concerned about the safety of continuing sex with her partner during pregnancy. Which suggestion should the nurse mention to her? Select all that apply.
-Sex is to be avoided after your membranes have ruptured. -Partner oral-female genital contact due to risk of air embolism. -Sex is generally not harmful to the fetus. -A nonmonogamous sexual partner should wear a condom.
The nurse is reviewing client data following a regular monthly appointment at 6 months' gestation. Which fundal height requires no further intervention?
24 cm
The nurse is assigned to clients who are having the following procedures: amniocentesis, fetal nonstress test, chorionic villus sampling, percutaneous umbilical blood sampling, and Doppler assessment of fetal heart rate. For which clients will the nurse ensure that signed informed consent has been given and is in the client's record?
Amniocentesis, chorionic villus sampling, percutaneous umbilical blood sampling
A nurse is educating a primigravida client about the expected changes during pregnancy. Which measure will provide anticipatory guidance about pregnancy?
Avoid wearing high heels, especially during late pregnancy.
A client in her second trimester of pregnancy has developed varicose veins and experiences leg cramps. Which suggestion would be most appropriate?
Elevate legs while sitting.
A contraction stress test is commonly performed in place of a biophysical profile.
FALSE
The nurse is educating a woman about the importance of folic acid before conception and during pregnancy, to prevent neural tube defects in the fetus. The client plans to take prenatal vitamins and minerals. What food source would the nurse recommend to add to the woman's diet?
Green leafy vegetables
A 28-year-old client who has just conceived arrives at a health care facility for her first prenatal visit to undergo a physical examination. Which intervention should the nurse perform to prepare the client for the physical examination?
Instruct the client to empty her bladder.
The nurse is assessing a client at her first prenatal visit and reports her LMP started December 1. Which date will the nurse predict for the EDD?
September 8 According to Naegele rule, the estimated date of birth is September 8. Add 7 days and subtract 3 months to the LMP to determine the estimated date of birth.
The nurse is reviewing all of the documentation on determining estimated date of delivery. Which objective data is included? Select all that apply.
sonogram fundal height calculating Naegele rule
The heat associated with saunas and hot tubs may cause fetal ___________.
tachycardia
The nurse educates the vegetarian client about which nutritional need during pregnancy?
taking a B12 supplement B12 is found almost exclusively in animal proteins and therefore is absent in the vegetarian diet. Fiber and dark green vegetables are needed. Vitamins A and C are not protein based and are found in a vegetarian diet.
The nurse is assisting a primigravida on calculating the due date of her baby using Naegele rule. The most important information provided by the mother is:
the first day of the last menstrual period.
The nurse is assisting a primigravida on calculating the due date of her baby using Naegele rule. The most important information provided by the mother is:
the first day of the last menstrual period. Naegele rule is calculated using the first day of the last menstrual period. From there, 7 days are added and then 3 months are subtracted. The ovulation date, intercourse date, or last day of the menstrual period are not needed.
At 24 weeks' gestation a client is asked to drink a sweet orange solution and then wait an hour to have blood drawn. The client asks if this is the test to determine if she has diabetes. What is the best response by the nurse?
"This is a screening procedure. If your result is elevated you will be scheduled for a longer test to determine if you have gestational diabetes." A glucose tolerance test involves a glucose load and a blood glucose level 1 hour later. It is a screening test used to determine if the client needs a full 3-hour oral glucose tolerance test. A 1-hour glucose tolerance test is not diagnostic of insulin resistance nor gestational diabetes. If the screening test is elevated the client is scheduled for the diagnostic test at approximately 24 to 26 weeks' gestation. If a client is eventually diagnosed with gestational diabetes, the initial treatment is diet therapy, not insulin.
A client in her third month of pregnancy arrives at the health care facility for a regular follow-up visit. The client reports discomfort due to increased urinary frequency. Which instruction should the nurse offer the client to reduce the client's discomfort?
Avoid consumption of caffeinated drinks. To reduce the client's urinary frequency, the nurse should instruct the client to avoid consuming caffeinated drinks, since caffeine stimulates voiding patterns. The nurse instructs the client to drink fluids between meals rather than with meals if the client complains of nausea and vomiting. The nurse instructs the client to avoid an empty stomach at all times, to prevent fatigue. The nurse also instructs the client to munch on dry crackers or toast early in the morning before arising if the client experiences nausea and vomiting; this would not help the client experiencing urinary frequency.
Which of these cardiac variations, if found in the client who is pregnant, should the nurse recognize as a normal finding in pregnancy?
soft systolic murmur A soft systolic murmur is common in pregnancy secondary to the increased blood volume. The other findings are not normal and require further assessment by the nurse.
A nurse is conducting a class geared toward changes in early pregnancy and self-care items like perineal hygiene. A woman shares that she douches at least once a day since she has "so much discharge" from her vagina. Which response by the nurse is most appropriate at this time?
"During pregnancy, you should not douche because it can cause fluid to enter the cervix resulting in an infection."
When providing preconception care to a client, which instruction will the nurse to provide about medications during pregnancy?
"You need to talk with your health care provider about using all prescription, over-the-counter, and herbal medications."
Urinary frequency is a common complaint during the _______and third trimesters
First
A nurse at the health care facility assesses a client at 20 weeks' gestation. The client is healthy and progressing well, without any sign of complications. Where should the nurse expect to measure the fundal height in this client?
at the level of the umbilicus
A nurse is taking a history during a client's first prenatal visit. Which assessment finding would alert the nurse to the need for further assessment?
history of diabetes for 4 years
The nurse is providing care for a pregnant client who has been given the necessary requisitions for laboratory work by the primary care provider. The client notices that the lab tests include testing for HIV and other sexually transmitted infections, and expresses alarm, stating, "I don't understand why the doctor would suspect that I've got these diseases." What is the nurse's most therapeutic statement?
"Every pregnant client is tested for these diseases; it doesn't necessarily suggest that the doctor suspects that you have them."
The nurse is conducting a teaching session for breastfeeding mothers. Which statement by a mother requires further clarification by the nurse?
"I am glad I can have my two cups of coffee in the morning again."
A primigravida at her 12-week prenatal visit expresses concern that she hasn't felt her baby move yet. What is the best response from the nurse?
"You usually cannot feel them until approximately 16 to 20 weeks."
The nurse assesses a 20-week gestational client at a routine prenatal visit. What will the nurse predict the fundal height to be on this client experiencing an uneventful pregnancy?
20 cm Between weeks 18 and 32 the fundal height in centimeters should match the gestational age of the pregnancy. At 20 weeks' the fundal height should be at the umbilicus. A fundal height smaller than expected can indicate that the original dates were miscalculated, oligohydramnios, or that the fetus is smaller than expected. If the fundal height is larger than expected this can indicate multiple gestation, the original dates were miscalculated, polyhydramnios, or a molar pregnancy.
At 32 weeks' gestation a client with a BMI of 23 has gained 24 lb (11 kg). What is the nurse's recommendation for weight gain for the remainder of this pregnancy?
Continue to gain approximately 1 lb (.45 kg) per week during this pregnancy.
A client who is uncertain when her LMP occurred is given an EDD of April 23 after the first ultrasound. Based on this information, the nurse determines the client's LMP was probably which day?
July 16
A multigravida client is pregnant for the third time. Her previous two pregnancies ended in an abortion in the first and third month of pregnancy. How will the nurse classify her pregnancy history?
G3 P0020
The nurse is assisting a pregnant client who underwent a nonstress test that was ruled reactive. Which factor will the nurse point out when questioned by the client about the results?
The fetal heart rate increases with activity and indicates fetal well-being.
The nurse discovers a new prescription for Rho(D) immune globulin for a client who is about to undergo a diagnostic procedure. The nurse will administer the Rho(D) immune globulin after which procedure?
amniocentesis Amniocentesis is an invasive procedure whereby a needle is inserted into the amniotic sac to obtain a small amount of fluid. This places the pregnancy at risk for a woman with Rh(D)-negative blood, since the puncture can allow the seepage of blood and amniotic fluid into the woman's system. She should receive Rho(D) immune globulin after the procedure to protect her and future babies. The CST, NST, and a biophysical profile are noninvasive tests.
Some pregnant women hire a trained professional to provide support during pregnancy and birth, to provide emotional support during labor and birth, and to aid in establishing breastfeeding. What is the name of the woman who takes this role?
doula The pregnant woman may hire a doula to provide support for labor and birth and help with establishing breastfeeding. A doula can also provide support for the postpartum period.
Nausea and vomiting are common reports during pregnancy. What nutritional action can be used to lessen nausea and vomiting?
limiting intake of heavy, greasy foods Nausea and vomiting can be lessened by limiting intake of fatty and greasy foods and eating small frequent meals every 2 to 3 hours. Other interventions include eating carbohydrate foods such as dry crackers, Melba toast, dry cereal, or hard candy before getting out of bed in the morning. Avoid drinking liquids with meals; avoid coffee, tea, and spicy foods; and eliminate individual food intolerances. Drinking liquids, increasing fluid intake, and limiting carbohydrate intake does not lessen nausea and vomiting.
A nurse is teaching a client who is 30 weeks' pregnant about ways to deal with pyrosis (heartburn). The nurse determines a need for additional teaching based on which client statement?
"I should lie down for 1/2 hour after eating." The client should remain sitting for 1 to 3 hours after eating and avoid lying down within 3 hours of eating. Cutting out caffeine, chewing food slowly, and raising the head of the bed are helpful in reducing pyrosis (heartburn) of pregnancy.
A nurse is collecting data during an admission assessment of a client who is pregnant with twins. The client has a 4-year-old child who was delivered at 38 weeks' gestation and tells the nurse that she does have a history of spontaneous abortion (miscarriage) within the first trimester. The nurse is correct to document the history as:
G = 3, T = 1, P = 0, A = 1, L = 1
A pregnant woman comes to the clinic for a prenatal visit for her third pregnancy. She reveals she had a previous miscarriage at 12 weeks and her 3-year-old son was born at 32 weeks. How should the nurse document this woman's obstetric history?
G3, T0, P1, A1, L1
A nurse is classifying the pregnancy history of a woman who has had five pregnancies: three full-term, one preterm, and one abortion, with four children still living. How would the nurse document this information on the client's chart using the GTPAL system?
G5 T3 P1 A1 L4
A client in her third trimester of pregnancy visits the health care center and asks why she is constipated. The nurse would include which most likely cause when responding to the client?
pressure on intestine by the growing fetus The nurse should explain that constipation often occurs during the third trimester because the growing fetus exerts pressure on the intestine. Engorgement of veins by the weight of the uterus causes varicosities. Pressure of the fetal head on the bladder increases the frequency of urination. Relaxation of the cardioesophageal sphincter causes heartburn.
