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INTRAUTERINE PREGNANCY

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INTRODUCTION

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Adolescent pregnancy is an important pediatric health concern. Pediatricians and general practitioners can play a vital role in the early diagnosis of pregnancy and promoting prenatal care. The World Health Organization reports a global average teenage birth rate among 15- to 19-year-olds of 49 births per 1000 females. Globally, the second leading cause of death in females aged 15 to 19 is complications occurring during pregnancy or delivery. The teenage birth rate in the United States has dramatically declined over the last 2 decades. The current preliminary rate of 22.3 per 1000 females aged 15 to 19 years is the lowest recorded rate.

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HISTORY

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During any assessment of an adolescent female, it is advisable to record the date and normality of the last menstrual period. Once menarche is achieved, pregnancy should be ruled out any time a sexually active patient reports missing 1 or more menses. A history of unprotected intercourse since the last menses with or without amenorrhea or unusual vaginal bleeding should alert the physician to the possibility of pregnancy. The absence of historical information does not preclude pregnancy because the adolescent may be unwilling or unable to communicate a sexual history to the clinician for a variety of reasons. The typical symptoms associated with pregnancy (nausea, vomiting, intermenstrual spotting, breast tenderness, unexplained weight gain, urinary frequency, and fatigue, among others) may be present in any combination or may be absent early in pregnancy (Table 80-1).

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Table Graphic Jump Location
TABLE 80-1Signs and Symptoms of Pregnancy
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PHYSICAL EXAMINATION

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A physical assessment, often including a pelvic examination, is critical to the evaluation of a possible pregnancy. Uterine size can be estimated based on a bimanual exam; in general, at 6 weeks, the uterus may be slightly softened but enlargement is difficult to appreciate, an 8-week uterus is about the size of an orange, and a 12-week uterus is the size of a grapefruit. As pregnancy progresses, the uterine fundus can be appreciated via an abdominal exam after 12 weeks, a 16-week uterus can be felt at the midpoint between the pubic symphysis and the umbilicus, and a 20-week uterus at the umbilicus.

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EVALUATION FOR PREGNANCY

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The first day of the last menstrual period forms the basis of dating of pregnancy. The urine or serum pregnancy test confirms the presence of an early pregnancy, using detection of beta-human chorionic gonadotropin (β-hCG). Within 24 ...

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