Pregnancy (main)
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 |
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
Maternal vitals and labs in pregnancy
Repeat B-hCG Levels
| Pregnancy Type | B-hCG Change |
| Normal |
|
| Ectopic |
|
| Miscarriage |
|
^Initial level CANNOT be used to rule-out ectopic
Management
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
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.