Pregnancy, Uncomplicated

Basics

Description

  • Pregnancy is a physiologic state, not a disease process
  • It involves severe metabolic stresses on the mother to facilitate fetal growth and development:
    • Changes occur due to large amounts of placental progesterone and estrogen
  • All women of reproductive age with abdominal pain should have pregnancy considered as part of their workup/differential

Pediatric Considerations

  • Average menarche in the US is 11–15 yr old
  • Pregnant adolescents who present to the ED may be either unaware of the pregnancy or reluctant to admit it:
    • Always consider pregnancy in adolescents, regardless of the chief complaint

Etiology

  • Placental human chorionic gonadotropin (hCG):
    • Prevents the normal involution of the corpus luteum at the end of the menstrual cycle
    • Causes the corpus luteum to secrete even larger quantities of estrogen and progesterone
    • Elevated hCG levels are responsible for nausea and vomiting
  • Placental progesterone:
    • Causes decidual cells in the endometrium to develop and provide nutrition for the early embryo
    • Decreases contractility of the gravid uterus and risk of spontaneous abortion
    • Helps estrogen prepare the breasts for lactation
  • Placental estrogen:
    • Responsible for enlargement of uterus, breasts, and mammary ducts
    • Enlargement of female external genitalia, relaxation of pelvic ligaments, symphysis pubis, and sacroiliac joints

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