Pregnancy (main)

(Redirected from Fundal exam in pregnancy)
The printable version is no longer supported and may have rendering errors. Please update your browser bookmarks and please use the default browser print function instead.

Background

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

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[1]

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

Vaginal Bleeding in Pregnancy (<20wks)

Abdominal Pain in Pregnancy

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

<20 Weeks

>20 Weeks

Any time

3rd Trimester/Postpartum Emergencies

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

See Also

References

  1. Vasquez V, Desai S. Labor and delivery and their complications. In: Walls RM, Hockberger RS, Gausche-Hill M, et al., eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier Saunders; 2018:2296–2312.