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Pregnancy

Pregnancy is the time during which one or more offspring develops (gestates) inside a woman's uterus (womb).[4][13] A multiple pregnancy involves more than one offspring, such as with twins.[14]

This article is about pregnancy in humans. For other mammals, see Pregnancy (mammals). For fish, see Pregnancy in fish.

Pregnancy usually occurs by sexual intercourse, but can also occur through assisted reproductive technology procedures.[6] A pregnancy may end in a live birth, a miscarriage, an induced abortion, or a stillbirth. Childbirth typically occurs around 40 weeks from the start of the last menstrual period (LMP), a span known as the gestational age.[4][5] This is just over nine months. Counting by fertilization age, the length is about 38 weeks.[5][13] Pregnancy is "the presence of an implanted human embryo or fetus in the uterus"; implantation occurs on average 8–9 days after fertilization.[15] An embryo is the term for the developing offspring during the first seven weeks following implantation (i.e. ten weeks' gestational age), after which the term fetus is used until birth.[5]


Signs and symptoms of early pregnancy may include missed periods, tender breasts, morning sickness (nausea and vomiting), hunger, implantation bleeding, and frequent urination.[1] Pregnancy may be confirmed with a pregnancy test.[7] Methods of birth control—or, more accurately, contraception—are used to avoid pregnancy.


Pregnancy is divided into three trimesters of approximately three months each. The first trimester includes conception, which is when the sperm fertilizes the egg. The fertilized egg then travels down the fallopian tube and attaches to the inside of the uterus, where it begins to form the embryo and placenta. During the first trimester, the possibility of miscarriage (natural death of embryo or fetus) is at its highest. 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 with high-quality medical care, though babies born at this time will likely experience serious health complications such as heart and respiratory problems and long-term intellectual and developmental disabilities.


Prenatal care improves pregnancy outcomes.[9] Nutrition during pregnancy is important to ensure healthy growth of the fetus.[16] Prenatal care may also include avoiding recreational drugs (including tobacco and alcohol), taking regular exercise, having blood tests, and regular physical examinations.[9] Complications of pregnancy may include disorders of high blood pressure, gestational diabetes, iron-deficiency anemia, and severe nausea and vomiting.[3] In the ideal childbirth, labor begins on its own "at term".[17] Babies born before 37 weeks are "preterm" and at higher risk of health problems such as cerebral palsy.[4] Babies born between weeks 37 and 39 are considered "early term" while those born between weeks 39 and 41 are considered "full term".[4] Babies born between weeks 41 and 42 weeks are considered "late-term" while after 42 weeks they are considered "post-term".[4] Delivery before 39 weeks by labor induction or caesarean section is not recommended unless required for other medical reasons.[18]

Demographics and statistics

About 213 million pregnancies occurred in 2012, of which, 190 million (89%) were in the developing world and 23 million (11%) were in the developed world.[11] The number of pregnancies in women aged between 15 and 44 is 133 per 1,000 women.[11] About 10% to 15% of recognized pregnancies end in miscarriage.[2] In 2016, complications of pregnancy resulted in 230,600 maternal deaths, down from 377,000 deaths in 1990.[12] Common causes include bleeding, infections, hypertensive diseases of pregnancy, obstructed labor, miscarriage, abortion, or ectopic pregnancy.[12] Globally, 44% of pregnancies are unplanned.[27] Over half (56%) of unplanned pregnancies are aborted.[27] Among unintended pregnancies in the United States, 60% of the women used birth control to some extent during the month pregnancy began.[28]

Tiredness

Morning sickness

Constipation

Pelvic girdle pain

Back pain

. Occasional, irregular, and often painless contractions that occur several times per day.

Braxton Hicks contractions

swelling of the lower limbs. Common complaint in advancing pregnancy. Can be caused by inferior vena cava syndrome resulting from compression of the inferior vena cava and pelvic veins by the uterus leading to increased hydrostatic pressure in lower extremities.

Peripheral edema

often caused by compression of both the inferior vena cava and the abdominal aorta (aortocaval compression syndrome).

Low blood pressure

. A common complaint, caused by increased intravascular volume, elevated glomerular filtration rate, and compression of the bladder by the expanding uterus.

Increased urinary frequency

[29]

Urinary tract infection

. Common complaint caused by relaxation of the venous smooth muscle and increased intravascular pressure.

Varicose veins

(piles). Swollen veins at or inside the anal area. Caused by impaired venous return, straining associated with constipation, or increased intra-abdominal pressure in later pregnancy.[30]

Hemorrhoids

heartburn, and nausea.

Regurgitation

Stretch marks

is common during the first trimester, and is more common in women who are pregnant at a young age.[31]

Breast tenderness

also known as the mask of pregnancy, is a discoloration, most often of the face. It usually begins to fade several months after giving birth.

Melasma

The usual signs and symptoms of pregnancy do not significantly interfere with activities of daily living or pose a health-threat to the mother or baby. However, pregnancy complications can cause other more severe symptoms, such as those associated with anemia.


Common signs and symptoms of pregnancy include:

Directly calculating the days since the beginning of the .

last menstrual period

Early , comparing the size of an embryo or fetus to that of a reference group of pregnancies of known gestational age (such as calculated from last menstrual periods), and using the mean gestational age of other embryos or fetuses of the same size. If the gestational age as calculated from an early ultrasound is contradictory to the one calculated directly from the last menstrual period, it is still the one from the early ultrasound that is used for the rest of the pregnancy.[34]

obstetric ultrasound

In case of , calculating days since oocyte retrieval or co-incubation and adding 14 days.[35]

in vitro fertilization

Embryo at 4 weeks after fertilization (gestational age of 6 weeks)

Embryo at 4 weeks after fertilization (gestational age of 6 weeks)

Fetus at 8 weeks after fertilization (gestational age of 10 weeks)

Fetus at 8 weeks after fertilization (gestational age of 10 weeks)

Fetus at 18 weeks after fertilization (gestational age of 20 weeks)

Fetus at 18 weeks after fertilization (gestational age of 20 weeks)

Fetus at 38 weeks after fertilization (gestational age of 40 weeks)

Fetus at 38 weeks after fertilization (gestational age of 40 weeks)

the presence of (hCG) in the blood and urine

human chorionic gonadotropin

missed

menstrual period

that occurs at implantation of the embryo in the uterus during the third or fourth week after last menstrual period

implantation bleeding

increased sustained for over two weeks after ovulation

basal body temperature

(bluish discolouration of the cervix, vagina, and vulva)

Chadwick's sign

(softening of the vaginal portion of the cervix)

Goodell's sign

(softening of the uterine isthmus)

Hegar's sign

of the linea alba, called linea nigra (darkening of the skin in a midline of the abdomen, resulting from hormonal changes, usually appearing around the middle of pregnancy).[72][73]

Pigmentation

Darkening of the nipples and areolas due to an increase in hormones.

[74]

consumed during pregnancy can cause one or more fetal alcohol spectrum disorders.[59] According to the CDC, there is no known safe amount of alcohol during pregnancy and no safe time to drink during pregnancy, including before a woman knows that she is pregnant.[109]

Alcoholic drinks

can cause a wide range of behavioral, neurological, and physical difficulties.[110] Smoking during pregnancy causes twice the risk of premature rupture of membranes, placental abruption and placenta previa.[111] Smoking is associated with 30% higher odds of preterm birth.[112]

Tobacco smoking during pregnancy

is associated with premature birth, birth defects and attention deficit disorder.[59]

Prenatal cocaine exposure

can cause premature birth and congenital abnormalities.[113] Short-term neonatal outcomes in methamphetamine babies show small deficits in infant neurobehavioral function and growth restriction.[114] Long-term effects in terms of impaired brain development may also be caused by methamphetamine use.[113]

Prenatal methamphetamine exposure

has been shown to be teratogenic in large doses in animals, but has not shown any teratogenic effects in humans.[59]

Cannabis in pregnancy

Pregnancy induced hypertension

[145]

Anemia

a common but solvable complication following childbirth that may result from decreased hormonal levels.[146]

Postpartum depression

Postpartum psychosis

with an increased risk due to hypercoagulability in pregnancy. These are the leading cause of death in pregnant women in the US.[147][148]

Thromboembolic disorders

(PUPPP), a skin disease that develops around the 32nd week. Signs are red plaques, papules, and itchiness around the belly button that then spreads all over the body except for the inside of hands and face.

Pruritic urticarial papules and plaques of pregnancy

including abdominal pregnancy, implantation of the embryo outside the uterus

Ectopic pregnancy

excessive nausea and vomiting that is more severe than normal morning sickness.

Hyperemesis gravidarum

a blood clot that forms in the legs and migrates to the lungs.[148]

Pulmonary embolism

is a rare complication thought to be brought about by a disruption in the metabolism of fatty acids by mitochondria.

Acute fatty liver of pregnancy

deals with the interactions of diabetes mellitus (not restricted to gestational diabetes) and pregnancy. Risks for the child include miscarriage, growth restriction, growth acceleration, large for gestational age (macrosomia), polyhydramnios (too much amniotic fluid), and birth defects.

Diabetes mellitus and pregnancy

can, if uncorrected, cause adverse effects on fetal and maternal well-being. The deleterious effects of thyroid dysfunction can also extend beyond pregnancy and delivery to affect neurointellectual development in the early life of the child. Demand for thyroid hormones is increased during pregnancy, which may cause a previously unnoticed thyroid disorder to worsen.

Thyroid disease in pregnancy

Untreated can cause a miscarriage, intrauterine growth restriction, small for gestational age, low birthweight and preterm birth. Often reproductive disorders are the only manifestation of undiagnosed celiac disease and most cases are not recognized. Complications or failures of pregnancy cannot be explained simply by malabsorption, but by the autoimmune response elicited by the exposure to gluten, which causes damage to the placenta. The gluten-free diet avoids or reduces the risk of developing reproductive disorders in pregnant women with celiac disease.[154][155] Also, pregnancy can be a trigger for the development of celiac disease in genetically susceptible women who are consuming gluten.[156]

celiac disease

confers an increased rate of fetal death in utero, miscarriage, and of neonatal lupus.

Lupus in pregnancy

is the propensity of pregnant women to develop thrombosis (blood clots). Pregnancy itself is a factor of hypercoagulability (pregnancy-induced hypercoagulability), as a physiologically adaptive mechanism to prevent postpartum bleeding.[157] However, in combination with an underlying hypercoagulable state, the risk of thrombosis or embolism may become substantial.[157]

Hypercoagulability in pregnancy

A pregnant woman may have a pre-existing disease, which is not directly caused by the pregnancy, but may cause complications to develop that include a potential risk to the pregnancy; or a disease may develop during pregnancy.

Couvade syndrome

Cryptic pregnancy

False pregnancy

Simulated pregnancy

Pregnancy-related anxiety

at Curlie

Pregnancy

– further details on the diseases, disorders, etc., which may complicate pregnancy.

Merck Manual Home Health Handbook

– NHS guide to having a baby including preconception, pregnancy, labor, and birth.

Pregnancy care