Pregnancy, Uncomplicated



  • 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

Pediatric Considerations
  • 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


  • 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

There's more to see -- the rest of this topic is available only to subscribers.