Pregnancy (main)
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Background
Clinical Features
Normal Vitals in Pregnancy[1]
Vital | Nonpregnant | 1st Trimester | 2nd Trimester | 3rd Trimester |
HR | 70 | 78 | 82 | 85 |
SBP | 115 | 112 | 112 | 114 |
DBP | 70 | 60 | 63 | 70 |
Hcrt | 40 | 36 | 33 | 34 |
WBC | 7.2k | 9.1k | 9.7k | 9.8k |
Estimated Gestational Age by Fundal Height[2]
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 |
Physiologic Changes in Pregnancy[3]
- Heart rate (HR) increases 15-20 bpm (75-95 bpm)
- Mean arterial pressure (MAP) increases 10 mmHg (80 mmHg)
- Tidal volume (TV) increases 40% (700 cc)
- Minute volume (MV) increases 40% (10.5 L/min)
- Functional residual capacity (FRC) decreases 25% (1300ml)
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
Vaginal Bleeding in Pregnancy (>20wks)
- Emergent delivery
- Placental abruption
- Placenta previa
- Vasa previa
- Uterine rupture
- Preterm labor
- Vaginal trauma
- Placenta accreta
- Intrauterine fetal demise
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 |
|
Ectopic |
|
Miscarriage |
|
^Initial level CANNOT be used to rule-out ectopic
Maternal Laboratory Changes in Pregnancy[4]
- CBC
- Increased WBC count (5k-15k)
- Decreased hematocrit (32-34%) due to increased plasma volume
- Decreased platelets
- Chemistry
- Decreased BUN and creatinine (<0.8mg/dL)
- GFR increases up to 60% (140ml/min)
- Decreased Bicarb
- Other
- Increased D-dimer and Fibrinogen
- Increased ESR ~78
- Decreased PaCO2 ~30
- ECG with Qs in III & aVF, left axis
- Beta-HCG Levels
Management
Disposition
- Uncomplicated pregnancy is managed as an outpatient
- For particular problems in pregnancy, see individual pages
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
External Links
References
- ↑ Kuklina EV, Ayala C, Callaghan WM. Hypertensive disorders and severe obstetric morbidity in the United States. Obstet Gynecol 2009; 113:1299-1306.
- ↑ 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.
- ↑ Kuklina EV, Ayala C, Callaghan WM. Hypertensive disorders and severe obstetric morbidity in the United States. Obstet Gynecol 2009; 113:1299-1306.
- ↑ Kuklina EV, Ayala C, Callaghan WM. Hypertensive disorders and severe obstetric morbidity in the United States. Obstet Gynecol 2009; 113:1299-1306.