Signs

Some clinical signs can be noted, but may be difficult to quantify:

■ Breast enlargement, tension, and venous distention—particularly obvious in the primigravida

■ Bimanual examination reveals a soft, cystic, globular uterus with enlargement consistent with the duration of pregnancy (see Table 3-1)

■ Chadwick's sign: Bluish discoloration of vagina and cervix, due to congestion of pelvic vasculature

PREGNANCY TESTING

How?

The beta subunit of human chorionic gonadotropin (hCG) is detected in maternal serum or urine.

■ hCG is a glycoprotein produced by the developing placenta shortly after implantation

Some women experience vaginal bleeding in pregnancy, and therefore fail to recognize their condition.

Nausea and/or vomiting occurs in approximately 50% of pregnancies, most notably at 2 to 12 weeks' GA, and typically in the a.m.

Hyperemesis gravidarium-persistent vomiting that results in weight loss, dehydration, acidosis from starvation, alkylosis from loss of HCl in vomitus, and hCG is a glycoprotein hormone composed of alpha and beta subunits.

TABLE 3-1. Fundal Height During Pregnancy

Weeks Pregnant

Fundal Height

TABLE 3-1. Fundal Height During Pregnancy

Weeks Pregnant

Fundal Height

12

Barely palpable above pubic symphysis

15

Midpoint between pubic symphysis and umbilicus

20

At the umbilicus

28

6 cm above the umbilicus

32

6 cm below the xyphoid process

36

2 cm below xyphoid process

40

4 cm below xiphoid processa

a Due to engagement and descent of the fetal head, the fundal height at 40 weeks is typically less than the fundal height at 36 weeks.

a Due to engagement and descent of the fetal head, the fundal height at 40 weeks is typically less than the fundal height at 36 weeks.

hCG is similar in structure and function to luteinizing hormone (the beta subunits are similar in both hormones).

The hCG alpha subunit is identical to that in luteinizing hormone (LH), follicle-stimulating hormone (FSH), and thyroid-stimulating hormone.

■ A monoclonal antibody to the hCG antigen is utilized ^ the hCG-antibody complex is measured qualitatively

Pregnancy tests not only detect hCG produced by the syncytiotrophoblast cells in the placenta, but also in:

■ Hydatidiform mole

■ Choriocarcioma

■ Other germ cell tumors

■ Ectopically producing breast cancers and large cell carcinoma of the lung

When?

■ Blood levels become detectably elevated 8 to 10 days after fertilization (3 to 3.5 weeks after the LMP)

■ hCG rises in a geometric fashion during T1, producing different ranges for each week of gestation:

Plasma hCG levels in early pregnancy should double every 48 hours.

Duration of Pregnancy (from Time of Ovulation)

1 week

2 weeks

Plasma hCG (mU/mL)

5-50 50-500 100-10,000 1,000-30,000 3,500-115,000 12,000-270,000 15,000-220,000 3,000-15,000

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