Pregnancy (main): Difference between revisions
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[[File:Pregnancy timeline.png|thumb|Timeline of pregnancy, including (from top to bottom): Trimesters, embryo/fetus development, gestational age in weeks and months, viability and maturity stages.]]
[[File:Pregnancy timeline.png|thumb|Timeline of pregnancy, including (from top to bottom): Trimesters, embryo/fetus development, gestational age in weeks and months, viability and maturity stages.]]
[[File:Bumm 123 lg - Copy.jpg|thumb|Estimated gestational age based on physical exam.]]
[[File:Bumm 123 lg - Copy.jpg|thumb|Estimated gestational age based on physical exam.]]
*[[Maternal Vitals and Labs in Pregnancy]]
*[[Maternal vitals and labs in pregnancy]]


==Clinical Features==
==Clinical Features==

Revision as of 17:22, 4 December 2024

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)

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
  • Minimum expected rise depends on initial hCG value:[2][3]
    • 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[4]
Miscarriage
  • Expected to decline >21-35% in 48 hrs[5]
  • A single hCG level cannot reliably distinguish intrauterine from ectopic pregnancy[6]
  • 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[7]

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.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ Murray H, Baakdah H, Bardell T, Tulandi T. Diagnosis and treatment of ectopic pregnancy. CMAJ. 2005; 173(8):905-912. PMID 16217116.
  7. ↑ 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.
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