Pregnancy (main)

Background

Timeline of pregnancy, including (from top to bottom): Trimesters, embryo/fetus development, gestational age in weeks and months, viability and maturity stages.

• Maternal Vitals and Labs in Pregnancy

Clinical Features

Melasma: pigment changes to the face due to pregnancy.

Linea nigra in a woman at 22 weeks pregnant.

Estimated Gestational Age by Fundal Height

Weeks	Fundal Height / Finding
12	Pubic symphysis
20	Umbilicus
20-32	Height (cm) above symphysis = gestational age (weeks)
36	Xiphoid process
>37	Regression
Post delivery	Umbilicus

Differential Diagnosis

Abdominal distention

• Obesity
• Intestinal obstruction
• Pregnancy
• Ascites
  • Cirrhosis
  • Malignancy
  • Heart failure
  • Tuberculosis
• Spontaneous bacterial peritonitis
• Peritoneal dialysis-associated peritonitis
• Distended bladder / Acute urinary retention
• Constipation / fecal impaction
• Large tumor(s) (e.g. ovarian, lymphoma)
• Organomegaly

Vaginal Bleeding in Pregnancy (<20wks)

• Ectopic pregnancy
• Subchorionic hematoma
• First Trimester Abortion
  • Complete Abortion
  • Incomplete Abortion
  • Inevitable Abortion
  • Missed Abortion
  • Septic abortion
  • Threatened Abortion
• Gestational trophoblastic disease
  • Consider when pregnancy-induced hypertension is seen before 24 wks of gestation
• Heterotopic pregnancy
• Implantation bleeding
• Molar pregnancy
• Non-pregnancy related bleeding
  • Cervicitis
  • Fibroids
  • Implantation bleeding

Abdominal Pain in Pregnancy

The same abdominal pain differential as non-pregnant patients, plus:

<20 Weeks

• Ectopic pregnancy
• First trimester abortion
  • Complete abortion
  • Threatened abortion
  • Inevitable abortion
  • Incomplete abortion
  • Missed abortion
  • Septic abortion
• Round ligament stretching
• Incarcerated uterus
• Malposition of the uterus

>20 Weeks

• Labor/Preterm labor
• Placental abruption
• Placenta previa
• Vasa previa
• Uterine rupture
• Vaginal trauma
• HELLP syndrome
• Cholestasis of pregnancy
• Chorioamnionitis
• Incarcerated uterus
• Acute fatty liver of pregnancy
• Malposition of the uterus
• Placenta accreta
• Placenta increta
• Placenta percreta

Any time

• Hemorrhagic ovarian cyst
• Fibroid degeneration or torsion
• Ovarian torsion
• Constipation

3rd Trimester/Postpartum Emergencies

• Acute fatty liver of pregnancy
• Amniotic fluid embolus
• Chorioamnionitis
• Eclampsia
• HELLP syndrome
• Mastitis
• Peripartum cardiomyopathy
• Postpartum endometritis (postpartum PID)
• Postpartum headache
• Postpartum hemorrhage
• Preeclampsia
• Resuscitative hysterotomy
• Retained products of conception
• Septic abortion
• Uterine rupture

Evaluation

Repeat B-hCG Levels

Pregnancy Type	B-hCG Change
Normal	Increase >53% in 48hrs (until 10,000 mIU/ml) Depends on the initial value: <1500 --> 50% increase 1500-3000 --> 40% increase > 3000 --> 30% increase
Ectopic	Increases or decreases slowly ("plateau")^
Miscarriage	Decreases >20% in 48 hrs

^Initial level CANNOT be used to rule-out ectopic

Management

• Drug Ratings in Pregnancy

See Also

• Headache during pregnancy
• Ectopic pregnancy
• ITP in Pregnancy
• Trauma in Pregnancy
• Comorbid Diseases in Pregnancy
• Abdominal pain in pregnancy
• Pulmonary Embolism in Pregnancy
• Vaccines in pregnancy
• Rashes of pregnancy
• Fundal Exam in Pregnancy
• Resuscitative hysterotomy