Pregnancy (main)

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Background

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

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.