Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:57

Pregnancy Complications for the Internist 1201

PREGNANCY COMPLICATIONS FOR THE INTERNIST

MAXINE H. DORIN, MD

REVISED BY ANDREW R. HOFFMAN, MD;

FREDRIC B. KRAEMER, MD, and THOMAS F. McELRATH, MD, PhD

history & physical

History

■Age, last normal menstrual period, menstrual pattern, birth control

method (past/present), number of pregnancies and outcome; his-

tory of STD, PID, IUD use, infertility

Has prenatal care been initiated?

Has intrauterine pregnancy been documented?

Prior pregnancy history

Prior seizure disorder

■Hypertension, thromboembolic events, liver disease, renal disease,

surgical history (esp. abdominal pelvic surgery)

■History of smoking

■Sexual activity

Signs & Symptoms

■Vaginal spotting/bleeding, abdominal/pelvic pain, breast tender-

ness, dizziness, gush of fluid

■Orthostatic changes, tachycardia, abdominal pain, peritoneal signs,

blood in vagina, bluish cervix

■Cervical os may be open with or without tissues present

■Soft, enlarged uterus or firm, normal-sized uterus, adnexal tender-

ness/fullness

tests

Laboratory

■Beta-HCG: qualitative

■CBC, Rh factor

■Consider beta-HCG quantitative, serum progesterone, AST, creati-

nine, BUN

■Urinary protein excretion (dip, spot protein/creatinine ratio, 24-hour

protein collection)

■Type/cross for blood

Screening

■Cervical cultures for GC/Chlamydia