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Pregnancy, Uncomplicated

Pregnancy, Uncomplicated is a topic covered in the 5-Minute Emergency Consult.

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Basics

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 with history of sterilization.
  • The changes in pregnancy occur from the production of large amounts of placental hormones:
    • Placental progesterone and estrogen

Pediatric Considerations
  • Range for menarche in 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:
    • Assume pregnancy in adolescents, regardless of the chief complaint
    • Pediatric pregnancies have an increased risk of obstructive labor

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

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Citation

Rosen, Peter, et al., editors. "Pregnancy, Uncomplicated." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307333/all/Pregnancy__Uncomplicated.
Pregnancy, Uncomplicated. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307333/all/Pregnancy__Uncomplicated. Accessed April 26, 2019.
Pregnancy, Uncomplicated. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307333/all/Pregnancy__Uncomplicated
Pregnancy, Uncomplicated [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 26]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307333/all/Pregnancy__Uncomplicated.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Pregnancy, Uncomplicated ID - 307333 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307333/all/Pregnancy__Uncomplicated PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -