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Because plasma volume increases more than red cell volume, the hematocrit during pregnancy can be expected to fall to as low as 35% by the beginning of the third trimester. Generally, a hemoglobin value of less…

Many reports have suggested that the frequency of exacerbations of systemic lupus erythematosus (SLE) is increased during pregnancy and the postpartum period. There are no convincing data, however, to support this concern. The natural…

Hyperemesis gravidarum is a condition of pregnant women in which intractable vomiting early in gestation causes dehydration, electrolyte disturbances, and/or nutritional deficiencies with accompanying weight loss. Also known as the “pernicious vomiting of pregnancy,” hyperemesis…

Most reports indicate that pregnancy has a favorable effect on the clinical course of rheumatoid arthritis. Up to 75% of patients experience a significant remission. Furthermore, remission during one pregnancy often indicates that a similar…

Both ulcerative colitis and Crohn’s disease have a predilection for young adults, with peak occurrence between the second and fourth decade of life. It is therefore not at all uncommon to encounter a woman…

Despite the cholestatic effect of estrogen and impaired gallbladder emptying, there is no proved increased incidence of acute cholecystitis or common duct obstruction during gestation. Cholecystectomy is performed in 1 per 1000 to 3000 pregnancies.…

Intrahepatic cholestasis of pregnancy (ICP) results from failure of the liver to excrete bile acids appropriately. Although the cause has not been clearly delineated, hormonal and genetic factors are suspected. ICP is more…

The most common cause of jaundice in pregnant women in the United States is viral hepatitis. With the exception of hepatitis E infection, the clinical course and histologic findings of hepatitis A, B, C, and…

Asthma is one of the most common illnesses and the most common obstructive pulmonary disease encountered during pregnancy. Asthma may occur for the first time during pregnancy. Approximately one third of pregnant women with asthma improve,…

Thromboembolic disease is the leading cause of nonobstetric postpartum maternal mortality. In the United States, one half of all thromboembolic events in women younger than 40 years are related to pregnancy. The risk of deep…

Normal pregnancy is accompanied by changes in blood volume, heart rate, blood pressure, cardiac output, and ventilation. Cardiac output begins to rise during the first trimester, peaks at an approximate 40% increase by 20 to…

Diagnosis. Without documentation of elevated blood pressure before pregnancy, chronic hypertension can only be presumed. The vast majority of patients who present with elevated blood pressure before the twentieth week of gestation, however, have chronic…

Diagnosis. Preeclampsia is a multiorgan disease unique to pregnancy. The condition is characterized by the development of elevated blood pressure, proteinuria, and generalized edema. The condition may also be recognized by visual changes, headache,…

Pregnancy is associated with a variety of anatomic and functional changes of the kidneys and lower urinary tract. Caliceal, pelvic, and ureteral dilatation occurs during the first trimester and persists throughout gestation up to 12…

Prolactin-secreting adenomas account for approximately 30% of all pituitary adenomas. Fewer than 7% of patients with intrasellar microadenomas (size less than 10 mm) manifest clinical evidence of tumor expansion during pregnancy. On the other hand,…

Primary hyperparathyroidism does not appear to impair fertility, but it is known to result in a high rate of fetal complications such as spontaneous abortions, stillbirths, and neonatal tetany. Maternal hyperparathyroidism causes maternal hypercalcemia, which in…

Gestational diabetes is defined as carbohydrate intolerance of variable severity with onset during the present pregnancy. The definition applies regardless of whether insulin is used for treatment or the condition persists after pregnancy, but it…

Several special considerations of thyroid dysfunction during pregnancy should be kept in mind. First, signs and symptoms of disordered thyroid function may be mimicked by pregnancy itself. Second, increases in thyroid-binding proteins during pregnancy alter…

Beginning in early gestation, glucose and various gluconeogenic amino acids reach the fetus against a concentration gradient by facilitated diffusion. Since maternal loss of glucose and gluconeogenic substrate to the fetus conspires to…

Pregnant women should not eat canned tuna because it may contain harmful levels of mercury, Consumer Reports magazine said on Monday, taking a more cautious approach than that recommended by…

Many variations occur in the complex process of human development. Although population heterogeneity is based on such events, some deviations from the usual developmental process result in aberrations of normal structure and function.…

A. Expectant Management
Because many ectopic pregnancies resolve spontaneously, it may be reasonable to manage an asymptomatic, compliant patient expectantly if β-hCG titers are low (< 200 mIU/mL) or decreasing, and the risk…

In tubal ectopic pregnancy, implantation is typically in the wall of the tube, in the connective tissue beneath the serosa. There may be little or no decidual reaction and minimal defense against the permeating…

Several special procedures are helpful in diagnosing ectopic pregnancy.

1. Ultrasound - Ultrasound is useful in evaluating patients at risk for ectopic pregnancy, namely by documenting the presence or absence of an intrauterine…

No specific symptoms or signs are pathognomonic for ectopic pregnancy, and many disorders can present similarly. Normal pregnancy, threatened or incomplete abortion, rupture of an ovarian cyst, ovarian torsion, gastroenteritis, and appendicitis can…