A. Symptoms

Amenorrhea, nausea and vomiting

B. Signs (in Weeks From Last Menstrual Period)

Breast changes (enlargement, vascular engorgement, colostrum) start to occur very early in pregnancy and continue until the postpartum period. Cyanosis of the vagina and cervical portio and softening of the cervix occur in about the 7th week. Softening of the cervicouterine junction takes place in the 8th week, and generalized enlargement and diffuse softening of the corpus occurs after the 8th week. When a woman’s abdomen will start to enlarge depends on her body habitus but typically starts in the 16th week.

The uterine fundus is palpable above the pubic symphysis by 12–15 weeks from the last menstrual period and reaches the umbilicus by 20–22 weeks. Fetal heart tones can be heard by Doppler at 10–12 weeks of gestation.

Differential Diagnosis

The nonpregnant uterus enlarged by myomas can be confused with the gravid uterus, but it is usually very firm and irregular. An ovarian tumor may be found midline, displacing the nonpregnant uterus to the side or posteriorly. Ultrasonography and a pregnancy test will provide accurate diagnosis in these circumstances.

 

Clinical Correlation

The formation of a corpus luteum cyst is a normal finding during pregnancy.

At times, the corpus luteum may be large and even rupture. Rupture of the corpus luteum results in an intraabdominal hemorrhage and severe abdominal pain, usually requiring surgery.

The corpus luteum secretes progesterone which is needed to maintain the pregnancy. After the first trimester, the corpus luteum will regress. In this case, the corpus luteum ruptured and was removed at 7 weeks (before the placenta can produce the hormone independently). Supplemental progesterone will be needed for this patient until after the first trimester to maintain the pregnancy. The risk of an ectopic pregnancy would be much higher if a viable pregnancy had not been seen in the uterus on ultrasound. The hormone hCG has two subunits, alpha and beta, and is produced early in the pregnancy by the placenta. The hCG rescues and maintains the corpus luteum's production of progesterone. The alpha subunit is similar to follicle-stimulating hormone (FSH), luteinizing hormone (LH), and thyroid-stimulating hormone (TSH). The beta subunit is unique to each hormone, and this is why the β-hCG level is measured to verify a pregnancy.

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Maintenance of the corpus luteum during the first 8 weeks of pregnancy is dependent on which of the following hormones?

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The correct answer is B.

 Maintenance of the corpus luteum and its secretion of progesterone are dependent on the hormone hCG. Trophoblastic tissue (syncytiotrophoblasts) produces hCG, with peak levels around 10 weeks of gestation. Pregnancy tests (serum or urine) detect the presence of hCG (specifically the beta subunit). hCG has two subunits: alpha and beta.

The alpha subunit is similar in structure to TSH, LH, and FSH.

 

Pregnancy Tests

All urine or blood pregnancy tests rely on the detection of human chorionic gonadotropin (hCG) produced by the placenta. Levels increase shortly after implantation, approximately double every 48 hours (this rise can range from 30% to 100% in normal pregnancies), reach a peak at 50–75 days, and fall to lower levels in the second and third trimesters. Pregnancy tests are performed on serum or urine and are accurate at the time of the missed period or shortly after it.

Compared with intrauterine pregnancies, ectopic pregnancies may show lower levels of hCG that plateau or fall in serial determinations. Quantitative assays of hCG repeated at 48-hour intervals are used in the diagnosis of ectopic pregnancy as well as in cases of molar pregnancy, threatened abortion, and missed abortion. Comparison of hCG levels between laboratories may be misleading in a given patient because different international standards may produce results that vary by as much as twofold. hCG levels can also be problematic because they require a series of measurements. Progesterone levels, however, remain relatively stable in the first trimester. A single measurement of progesterone is the best indicator of whether a pregnancy is viable, although there is a broad indeterminate zone. A value less than 5 ng/mL (16 nmol/L) predicts pregnancy failure while a value greater than 25 ng/mL (80 nmoL/L) indicates a pregnancy will be successful. There is uncertainty when the value is between these two points. Combining several serum biomarkers (beta hCG and progesterone) may provide a better prediction of pregnancy viability. Pregnancy of unknown location is a term used to describe a situation where a woman has a positive pregnancy test but the location and viability of the pregnancy is not known because it is not seen on transvaginal ultrasound.

Pregnancy detection with home pregnancy test kits

    The first morning urine is the best specimen for testing. The most accurate results are obtained by waiting at least 1 week after the date of the expected mentrual period.

    The urine collection container in the kit should be used and the urine tested immediately after collection.

    Common reasons for a test to be read as negative when a woman is actually pregnant include testing too early (i.e., on or before the first day of a missed period), using a waxed cup for urine collection, soap residue in the container used to collect urine, or testing refrigerated urine.

Unplanned Pregnancy

In the event of an unwanted pregnancy, counseling about adoption or termination of the pregnancy can be provided at an early stage.

  • Many women and their partners find themselves facing an unplanned pregnancy. Options include continuing the pregnancy and caring for the infant, continuing the pregnancy and placing the infant with an adoptive family, or ending the pregnancy via medical or surgical abortion. Couples need support and information to assist them with this decision.
  • Methods to prevent or terminate an unwanted pregnancy include the following:
    • Emergency contraceptives (ECs)—These oral methods can be used after unprotected intercourse or contraceptive failure to prevent pregnancy. These agents are not abortifacients and prevent pregnancy before implantation occurs. They do not disrupt an already established pregnancy and there are no evidence-based medical contraindications to their use. However, ECs, like other hormonal contraceptives, have the potential to inhibit implantation of a fertilized egg.11 The agents are most effective when the first dose is taken within 12 hours of unprotected intercourse; each 12-hour delay in beginning use reduces efficacy by 50%.
      1. The levonorgestrel product Plan B One-Step reduces the likelihood of pregnancy by 84%. Side effects include heavier menstrual bleeding (31%) and nausea (14%). The standard dosing regimen is one 1.5-mg tablet as soon as possible within 72 hours of unprotected intercourse. Clinical trials demonstrate reasonable efficacy rates up to 120 hours postcoitus. Next Choice is a generic version of the original Plan B and contains two 0.75-mg levonorgestrel doses which may be taken at once or 12 hours apart. Levonorgestrel is available to women age 17 years and older as a nonprescription product. The mechanism of action is delay/inhibition of ovulation; it does not prevent fertilization or interfere with blastocyst implantation. It does not affect an existing pregnancy and will not harm a fetus.12

      2. Ulipristal acetate (ella) is a selective progesterone receptor modulator that is also FDA approved as an emergency contraceptive for use for up to 5 days after unprotected intercourse or contraceptive failure. It is given as a single 30-mg dose; ella is only available by prescription. Use is not approved for patients younger than 18 years of age. Pregnancy should be excluded prior to prescribing ella. It is not known if ella will harm a developing fetus. Side effects include headache (18%), nausea (12%), fatigue (6%), dizziness (5%), and abdominal pain (12%).13 The mechanism of action is prevention/delay of the LH surge and follicular rupture—delay of ovulation; it may interfere with implantation of a blastocyst but the 30-mg dose may not prevent implantation (Planned Parenthood, 2010). Ella is more effective than levonorgestrel 72 to 120 hours after unprotected intercourse.14 Ella may make hormonal contraceptives less effective so a barrier method of birth control (e.g., condom) should be used in addition to hormonal contraceptives for the remainder of that same menstrual cycle.

      3. Use of oral contraceptives containing ethinyl estradiol, plus either levonorgestrel or norgestrel, reduces the likelihood of pregnancy by 75%.11Approximately 50% of users experience nausea and 20% experience vomiting. Use of oral contraceptives as ECs requires a regimen that includes 2 doses—1 dose taken as soon as possible within 72 hours of unprotected intercourse and the second dose taken 12 hours later. Each dose must include at least 100 mcg of ethinyl estradiol and either 1 mg of norgestrel or 0.5 mg of levonorgestrel.

    • Medical abortion (i.e., use of medications to induce an abortion)—Medical abortions account for 12% of the abortions performed in the United States.4 Medical abortion is an option for women who wish to terminate a pregnancy up to 63 days' gestation (calculated from the first day of the last menstrual period). The efficacy of the various regimens ranges from 88% to 99%. Regimens including 200 mg of oral mifepristone followed by 800 mcg of misoprostol vaginally from 6 to 8 hours to 72 hours afterwards been shown to be most effective with fewer side effects and lower cost.15,16SOR A Side effects of medical abortion using mifepristone and misoprostol include nausea (20% to 52%), thermoregulatory dysfunction (i.e., warmth, fever, chills, hot flashes; 9% to 56%), dizziness (12% to 37%), headache (10% to 37%), vomiting (5% to 30%), and diarrhea (1% to 27%).15
    • Surgical (aspiration) abortion—this method can be performed in the office up to 13 weeks' gestation and has a rate of major complications of less than 1 in 200 cases.4A Cochrane review found no data showing that any one procedure (manual or electrical vacuum aspiration or dilation and curettage) is superior.17

 

  • Pregnancy prevention—Use of contraceptives dramatically reduces the likelihood of unplanned pregnancy (only 8% of women per year using oral contraceptives become pregnant and of women whose partners are using a condom only 15% become pregnant).1 Many pregnancies occur when a woman discontinues a contraceptive method and does not begin use of another method prior to intercourse; women should be encouraged to have a backup method they can use if the chosen method proves unsatisfactory (see Chapter 3, Family Planning) and should be educated about the availability of the emergency contraception.
  • Abortion choices—Since the FDA approval of mifepristone for elective first trimester termination, medical abortion is increasingly common. In 2007, approximately 12% of abortions were performed using combinations of mifepristone and/or misoprostol.4
  • Pregnancy planning begins with preconception care, ideally occurring 3 to 6 months prior to the conception to discuss health promotion, risk assessment, and medical intervention.
  • Environmental exposures that adversely affect the fetus should be minimized (e.g., pesticides, paint thinner/strippers, fertilizers, and heavy metals). Women who work in hospital settings should avoid exposure to ionizing radiation, chemotherapeutic agents, and misoprostol.
  • Intake of 400 mcg/day of folic acid prior to and during the early part of pregnancy reduces the risk of neural tube defects. SOR A
  • Certain heritable genetic diseases can be diagnosed in individuals prior to becoming pregnant (e.g., sickle cell disease, cystic fibrosis).
  • Treatment of chronic medical conditions (e.g., diabetes, epilepsy, hypertension) can be optimized to reduce fetal loss and adverse effects, including possible change to medications safer in pregnancy.
  • Smoking cessation and eliminating alcohol consumption should be encouraged.
  • Immunizations (e.g., rubella, varicella) can be provided.
  • Patients should be encouraged to discuss their birthing preferences and their practitioner's practice style with respect to the routine use of technology.

 


relationships of the viscera to the abdominal regions changes during pregnancy. For example, the appendix lies in the right ilioinguinal region (right lower quadrant) until the 12th week of gestation. At 16 weeks, it is at the level of the right iliac crest. At 20 weeks, it is at the level of the umbilicus, where it will remain until after delivery. Because of this displacement, the symptoms of appendicitis will be different during the 3 trimesters. Similarly, displacement will also affect problems involving the bowel.

 

 

The period of gestation can be divided into units consisting of 3 calendar months each or 3 trimesters. The first trimester can be subdivided into the embryonic and fetal periods. The embryonic period starts at the time of fertilization (developmental age) or at 2 through 10 weeks' gestational age. The embryonic period is the stage at which organogenesis occurs and the time period during which the embryo is most sensitive to teratogens. The end of the embryonic period and the beginning of the fetal period occurs 8 weeks after fertilization (developmental age) or 10 weeks after the onset of the last menstrual period.

Definitions

The term gravid means “pregnant”; gravida is the total number of pregnancies that a women has had, regardless of the outcome.

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Parity is the number of births, both before and after 20 weeks' gestation, and comprises 4 components:

  1. Full-term births

  2. Preterm births: having given birth to an infant (alive or deceased) weighing 500 g or more, or at or beyond 20 completed weeks (based on the first day of the last menstrual period)

  3. Abortions: pregnancies ending before 20 weeks, either induced or spontaneous

  4. Living children

When gravidity and parity are calculated as part of the obstetric history, multiple births are designated as a single gravid event, and each infant is included as part of the parity total.

Live birth is the delivery of any infant (regardless of gestational age) that demonstrates evidence of life (eg, a heartbeat, umbilical cord pulsation, voluntary or involuntary movement), independent of whether the umbilical cord has been cut or the placenta detached. An infant is a live-born human from the moment of birth until the completion of 1 year of life (365 days).

A preterm infant is defined as one born between 20 weeks and 37 completed weeks of gestation (259 days). A term infant is one born between 37 0/7 and 40 0/7 weeks gestation (280 days). At term, a fetus usually weighs more than 2500 g. Depending on maternal factors such as obesity and diabetes, amniotic fluid volume, and genetic and racial factors, the baby may be larger or smaller than expected; therefore, the clinician must rely on objective data to determine fetal maturity. Fetal lung maturity is assumed after 39 weeks' gestation but can be verified at an earlier gestational age by analysis of amniotic fluid by amniocentesis.

A postterm infant is born after 42 weeks' gestation (294 days). A prolonged pregnancy may result in an excessive-size infant with diminished placental capacity. A postmature infant may exhibit characteristic cutaneous changes, including a loss of subcutaneous fat, wrinkled skin, and fine long hair on the arms. Predicting the end of a pregnancy is a difficult problem for prenatal care providers. Prenatal mortality rates increase as gestation advances past the due date (EDD) and accelerates sharply after 42 weeks' gestation. It is not uncommon to offer induction of labor after 41 completed weeks, or 7 days past the due date. (See Chapter 14 on Late Pregnancy Complications.) Estimated gestational age can be determined by methods outlined later for ascertaining fetal age and EDD.

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Increased morbidity and mortality may be associated with a macrosomic infant or a large for gestational age (LGA) fetus. This is defined as a fetus with an estimated fetal weight at or beyond the 90th percentile at any gestational age. At term, approximately 10% of newborn infants weigh more than 4000 g, and the weight of 1.5% of newborns is in excess of 4500 g. Excessive fetal size should be suspected in women with a previous macrosomic fetus or those with diabetes mellitus. A low-birth-weight infant is any live birth for which the infant's weight is less than or equal to 2500 g. An infant with fetal growth restriction is defined as one at or below the 10th percentile at any gestational age.

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Using a system based on the duration of gestational age or fetal weight, an abortion is the expulsion or extraction of part (incomplete) or all (complete) of the placenta or membranes without an identified fetus or with a fetus (alive or deceased) weighing less than 500 g or with an estimated gestational age of less than 20 completed weeks or 139 days from the last menstrual period, if fetal weight is unknown.

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Birth Rate & Fertility Rate

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Birth rate is defined as the number of live births per 1000 population. The fertility rate is expressed as the number of live births per 1000 women ages 15–44 years (sexually active population group). The current birth rate is 13.83 per 1000 population in 2010, whereas the general fertility rate is 66.7 per 1000 women ages 15–44 years.

Neonatal & Perinatal Periods

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The neonatal period is defined as birth until 28 days of life; during this interval, the infant is designated as a newborn or neonate. The perinatal period is the time from 28 weeks' gestation to the first 7 days of life; this also includes the late fetal and early neonatal period.

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The prenatal mortality rate is the sum of late fetal deaths plus early neonatal deaths (death in the first 7 days of life). The neonatal mortality rate (NMR) is infant death from birth to within 28 days of life. The NMR is calculated as the number of neonatal deaths during a year, divided by the number of live births during the same year, expressed per 1000 live births.

American College of Obstetricians and Gynecologists. Fetal Macrosomia. ACOG Practice Bulletin No. 22. Obstet Gynecol 2000;96.
Centers for Disease Control and Prevention. National Center for Health Statistics. http://www.cdc.gov/nchs/data_access/Vitalstatsonline.htm#Downloadable. Accessed January 10, 2011.
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Weeks of gestation (gestational age) are calculated from the first day of the last menstrual period.

The period of gestation can be divided into units consisting of 3 calendar months each or 3 trimesters. The first trimester can be subdivided into the embryonic and fetal periods. The embryonic period starts at the time of fertilization (developmental age) or at 2 through 10 weeks' gestational age. The embryonic period is the stage at which organogenesis occurs and the time period during which the embryo is most sensitive to teratogens. The end of the embryonic period and the beginning of the fetal period occurs 8 weeks after fertilization (developmental age) or 10 weeks after the onset of the last menstrual period.

The gestational age or menstrual age is the time elapsed since the first day of the last normal menstrual period (LNMP), which actually precedes the time of oocyte fertilization (conception). The gestational age is expressed in completed weeks. The menstrual gestational age of pregnancy is calculated at 280 days or 40 completed weeks. The estimated due date (EDD) may be estimated by adding 7 days to the first day of the last menstrual period and subtracting 3 months plus 1 year (Naegele's rule).

This starting time, which is usually about 2 weeks before ovulation and fertilization and nearly 3 weeks before blastocyst implantation, has traditionally been used because most women know their last period, assuming a 28-day regular menstrual cycle.

 

Trimesters

The period of gestation can be divided into units consisting of 3 calendar months each or 3 trimesters. The first trimester can be subdivided into the embryonic and fetal periods. The embryonic period starts at the time of fertilization (developmental age) or at 2 through 10 weeks' gestational age. The embryonic period is the stage at which organogenesis occurs and the time period during which the embryo is most sensitive to teratogens. The end of the embryonic period and the beginning of the fetal period occurs 8 weeks after fertilization (developmental age) or 10 weeks after the onset of the last menstrual period.

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A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy can occur by sexual intercourse or assisted reproductive technology. It usually last around 40 weeks (10 lunar months) from the last menstrual period (LMP) and ends inchildbirth.[1][3] This is about 38 weeks after conception. An embryo is the developing offspring during the first 8 weeks following conception, after which, the term fetus is used until birth.[3] Symptom of early pregnancy may include a missed periods, tender breasts,nausea and vomiting, hunger, and frequent urination.[4] Pregnancy may be confirmed with a pregnancy test.[5]

Pregnancy is typically divided into three trimesters. The first trimester is from week one through twelve and includes conception. Conception is followed by the fertilized egg traveling down the fallopian tube and attaching to the inside of the uterus, where it begins to form the fetus and placenta.[1] The first trimester carries the highest risk of miscarriage (natural death of embryo or fetus).[6] The second trimester is from week 13 through 28. Around the middle of the second trimester, movement of the fetus may be felt. At 28 weeks, more than 90% of babies can survive outside of the uterus if provided high-quality medical care. The third trimester is from 29 weeks through 40 weeks.[1]

Prenatal care improves pregnancy outcomes.[7] This may include taking extra folic acid, avoiding drugs and alcohol, regular exercise, blood tests, and regular physical examinations.[7] Complications of pregnancy may include high blood pressure of pregnancygestational diabetesiron-deficiency anemia, and severe nausea and vomiting among others.[8] Term pregnancy is 37 weeks to 41 weeks, with early term being 37 and 38 weeks, full term 39 and 40 weeks, and late term 41 weeks. After 41 weeks, it is known as post term. Babies born before 37 weeks are preterm and are at higher risk of health problems such as cerebral palsy.[1] It is recommended that delivery not be artificially started with either labor induction or caesarean section before 39 weeks unless required for other medical reasons.[9]

 

 

Gestational Age

The gestational age or menstrual age is the time elapsed since the first day of the last normal menstrual period (LNMP), which actually precedes the time of oocyte fertilization (conception). The gestational age is expressed in completed weeks. The menstrual gestational age of pregnancy is calculated at 280 days or 40 completed weeks. The estimated due date (EDD) may be estimated by adding 7 days to the first day of the last menstrual period and subtracting 3 months plus 1 year (Naegele's rule).

This starting time, which is usually about 2 weeks before ovulation and fertilization and nearly 3 weeks before blastocyst implantation, has traditionally been used because most women know their last period, assuming a 28-day regular menstrual cycle.

Developmental Age

The developmental or fetal age is the age of the conception calculated from the time of implantation, which is 4 to 6 days after ovulation is completed.

Embryologists describe embryo-fetal development in ovulation age, or the time in days or weeks from ovulation. Another term is postconceptional age, nearly identical to ovulation age.

Trimesters

The period of gestation can be divided into units consisting of 3 calendar months each or 3 trimesters. The first trimester can be subdivided into the embryonic and fetal periods. The embryonic period starts at the time of fertilization (developmental age) or at 2 through 10 weeks' gestational age. The embryonic period is the stage at which organogenesis occurs and the time period during which the embryo is most sensitive to teratogens. The end of the embryonic period and the beginning of the fetal period occurs 8 weeks after fertilization (developmental age) or 10 weeks after the onset of the last menstrual period.

.

A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy can occur by sexual intercourse or assisted reproductive technology. It usually last around 40 weeks (10 lunar months) from the last menstrual period (LMP) and ends inchildbirth.[1][3] This is about 38 weeks after conception. An embryo is the developing offspring during the first 8 weeks following conception, after which, the term fetus is used until birth.[3] Symptom of early pregnancy may include a missed periods, tender breasts,nausea and vomiting, hunger, and frequent urination.[4] Pregnancy may be confirmed with a pregnancy test.[5]

Pregnancy is typically divided into three trimesters. The first trimester is from week one through twelve and includes conception. Conception is followed by the fertilized egg traveling down the fallopian tube and attaching to the inside of the uterus, where it begins to form the fetus and placenta.[1] The first trimester carries the highest risk of miscarriage (natural death of embryo or fetus).[6] The second trimester is from week 13 through 28. Around the middle of the second trimester, movement of the fetus may be felt. At 28 weeks, more than 90% of babies can survive outside of the uterus if provided high-quality medical care. The third trimester is from 29 weeks through 40 weeks.[1]

Prenatal care improves pregnancy outcomes.[7] This may include taking extra folic acid, avoiding drugs and alcohol, regular exercise, blood tests, and regular physical examinations.[7] Complications of pregnancy may include high blood pressure of pregnancygestational diabetesiron-deficiency anemia, and severe nausea and vomiting among others.[8] Term pregnancy is 37 weeks to 41 weeks, with early term being 37 and 38 weeks, full term 39 and 40 weeks, and late term 41 weeks. After 41 weeks, it is known as post term. Babies born before 37 weeks are preterm and are at higher risk of health problems such as cerebral palsy.[1] It is recommended that delivery not be artificially started with either labor induction or caesarean section before 39 weeks unless required for other medical reasons.[9]

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The first day of the most recent menstrual period is traditionally used to calculate the estimated date of delivery (EDD) by using Naegele's rule (EDD = [first day of last menstrual period minus 3 months] plus 7 days).

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A 23-year-old woman presents to the emergency department with complaints of severe abdominal pain. She is known to be 7-weeks pregnant and did not have any problems with previous pregnancies. She denies any vaginal bleeding. On examination, the patient is in moderate distress and is slightly hypotensive with a normal pulse. Her abdomen is distended and tender on the right side with rebound and guarding. Her cervix is closed, and her uterus is consistent with 7 weeks of pregnancy. A Beta-human chorionic gonadotropin (β-hCG) is drawn and is positive. A stat blood count is drawn and demonstrates a drop in hemoglobin from blood work done 3 days earlier. An ultrasound is performed and demonstrates a viable singleton pregnancy in the uterus. There is also a large amount of free fluid in her abdomen, and a right adnexal mass is noted. The patient is taken to the operating room to investigate the right adnexal mass, pain, and free fluid. A ruptured corpus luteum is identified intraoperatively, along with a large amount of blood in the abdomen. After the bleeding corpus luteum is removed, the surgery is completed and patient is taken to the recovery room.

 

Summary: A 23-year-old woman at 7 weeks' gestation presents with acute abdominal pain from a ruptured corpus luteal cyst.

Questions

What is the function of the corpus luteum during the first trimester of a pregnancy?

Answer

Why does lactation not occur during pregnancy despite an increasing prolactin level?

Answer

Clinical Correlation

The formation of a corpus luteum cyst is a normal finding during pregnancy.

At times, the corpus luteum may be large and even rupture. Rupture of the corpus luteum results in an intraabdominal hemorrhage and severe abdominal pain, usually requiring surgery.

The corpus luteum secretes progesterone which is needed to maintain the pregnancy. After the first trimester, the corpus luteum will regress. In this case, the corpus luteum ruptured and was removed at 7 weeks (before the placenta can produce the hormone independently). Supplemental progesterone will be needed for this patient until after the first trimester to maintain the pregnancy. The risk of an ectopic pregnancy would be much higher if a viable pregnancy had not been seen in the uterus on ultrasound. The hormone hCG has two subunits, alpha and beta, and is produced early in the pregnancy by the placenta. The hCG rescues and maintains the corpus luteum's production of progesterone. The alpha subunit is similar to follicle-stimulating hormone (FSH), luteinizing hormone (LH), and thyroid-stimulating hormone (TSH). The beta subunit is unique to each hormone, and this is why the β-hCG level is measured to verify a pregnancy.

 

 

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A 26-year-old pregnant woman in her sixth week presents for her first prenatal visit. Ultrasound confirms fetal cardiac activity and length consistent with 6 weeks of pregnancy. It also shows a simple cyst measures 4-cm on the left ovary.

What is the best next step of management?

A-Assurance and follow up on next visits

B-Hormonal treatment

C-Surgical removal of the cyst

D-Termination of pregnancy

E-Wide spectrum antibiotics to prevent infection

The correct answer is A



This cyst is most likely the corpus luteum of pregnancy. It is significant for sustaining pregnancy through production of progesterone. Assurance and follow up for size and symptoms is recommended in the first trimester.

A 24-year-old woman comes to clinic for a routine visit. She is 28 weeks pregnant with her first child. To date, her pregnancy has been unremarkable and she has no family history of complicated pregnancies. Her past medical history is unremarkable except for a history of mitral valve prolapse. A blood pressure greater than which of the following would be considered potentially abnormally elevated?

A
110/80 mmHg in the standing position

B
120/80 mmHg in the standing position 2 minutes after rising from the supine position

C
130/85 mmHg in the left lateral recumbent position

D
130/85 mmHg in the seated position

E
140/90 mmHg in the seated position

Complete Quiz and View Results
You will be able to view all answers at the end of your quiz.
The correct answer is E. You answered B.

Explanation:
The answer is E. (Chap. 8) In pregnancy, cardiac output increases by 40%, with most of the increase due to an increase in stroke volume. Heart rate increases by ~10 bpm during the third trimester. In the second trimester, systemic vascular resistance decreases, and this decline is associated with a fall in blood pressure. During pregnancy, a blood pressure of 140/90 mmHg is considered to be abnormally elevated and is associated with an increase in perinatal morbidity and mortality. In all pregnant women, the measurement of blood pressure should be performed in the sitting position, because the lateral recumbent position may result in a blood pressure lower than that recorded in the sitting position. The diagnosis of pregnancy-associated hypertension requires the measurement of two elevated blood pressures at least 6 hours apart. Hypertension during pregnancy is usually caused by preeclampsia, chronic hypertension, gestational hypertension, or renal disease.

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