Pregnancy (main): Difference between revisions

Revision as of 19:23, 3 February 2021

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

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

Pregnancy Type	B-hCG Change
Normal	Minimum expected rise depends on initial hCG value:^[1]^[2] Initial hCG <1,500 mIU/mL: minimum 49% rise in 48hrs Initial hCG 1,500-3,000 mIU/mL: minimum 40% rise in 48hrs Initial hCG >3,000 mIU/mL: minimum 33% rise in 48hrs hCG typically doubles approximately every 48-72 hours in early pregnancy Rate of rise slows after hCG reaches approximately 6,000-10,000 mIU/mL
Ectopic	Increases or decreases more slowly than expected ("plateau") Approximately 21% of ectopic pregnancies have a normal hCG rise^[3]
Miscarriage	Expected to decline >21-35% in 48 hrs^[4]

A single hCG level cannot reliably distinguish intrauterine from ectopic pregnancy^[5]
The discriminatory zone (typically 1,500-3,500 mIU/mL depending on institution) is the hCG level above which a gestational sac should be visible on transvaginal ultrasound^[6]

↑ Barnhart KT, Sammel MD, Rinaudo PF, et al. Symptomatic patients with an early viable intrauterine pregnancy: HCG curves redefined. Obstet Gynecol. 2004; 104(1):50-55. PMID 15229000.
↑ Barnhart KT, Guo W, Cary MS, et al. Differences in serum human chorionic gonadotropin rise in early pregnancy by race and value at presentation. Obstet Gynecol. 2016; 128(3):504-511. PMID 27500347.
↑ Silva C, Sammel MD, Zhou L, et al. Human chorionic gonadotropin profile for women with ectopic pregnancy. Obstet Gynecol. 2006; 107(3):605-610. PMID 16507930.
↑ Doubilet PM, Benson CB, Bourne T, Blaivas M. Diagnostic criteria for nonviable pregnancy early in the first trimester. N Engl J Med. 2013; 369(15):1443-1451. PMID 24106937.
↑ Murray H, Baakdah H, Bardell T, Tulandi T. Diagnosis and treatment of ectopic pregnancy. CMAJ. 2005; 173(8):905-912. PMID 16217116.
↑ Connolly A, Ryan DH, Stuber AR, Postma HJ. Reevaluation of discriminatory and threshold levels for serum beta-hCG in early pregnancy. Obstet Gynecol. 2013; 121(1):65-70. PMID 23262929.

Authors:

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 *[[Rashes of pregnancy]]
 *[[Fundal Exam in Pregnancy]]
+*[[Resuscitative hysterotomy]]
 [[Category:OBGYN]]