Description

• Pregnancy is not a disease process but rather a physiologic state
• It involves severe metabolic stresses on the mother to facilitate the growth and development of the fetus
• All women of reproductive age with abdominal pain are considered pregnant until proven otherwise (even those with history of sterilization)
• The changes in pregnancy occur from the production of large amounts of placental hormones:
  • Placental progesterone and estrogen

• Range for menarche in the U.S. 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
  • Pediatric pregnancies have an increased risk of shoulder dystocia

Etiology

• Preceding signs and symptoms can be explained by elevations in various hormone levels or changes in anatomy that are a function of the progression of the pregnancy
• 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