A glycoprotein hormone secreted by the PLACENTA in early pregnancy, and stimulating the CORPUS LUTEUM within the ovary

(see OVARIES) to secrete OESTROGENS, PROGESTERONE, and relaxin. The hormone is essential for the maintenance of pregnancy up to about 68 weeks of gestation. A RADIOIMMUNOASSAY can be used to detect its presence, and pregnancy can be diagnosed as early as six days after conception by testing for it in the urine. Some tumours also secrete human chorionic gonadotrophin, particularly HYDATIDIFORM MOLE, which produces large amounts.

Human Chorionic Gonadotrophin

Multiple pregnancy and HYDATIDIFORM MOLE, together with hydrops fetalis (see HAEMOLYTIC DISEASE OF THE NEWBORN), predispose to early and severe pre-eclampsia.

For the first 12 weeks (the first trimester) the baby is known as an EMBRYO, after which it is referred to as the FETUS.

Definition: Endometritis is an infection of the endometrium.

Etiology: Endometritis is from an ascending infection from colonizing bacteria, and is typically a polymicrobial nfection with Group B Streptococcus, E. coli, E. faecalis as the most common infecting organisms. Cesarean delivery is the most important risk factor for endometritis. Other risk factors include internal monitors or many vaginal exams during labor, and prolonged rupture of membranes. Clinical Presentation: Uterine tenderness, fever, lower abdominal pain, and purulent lochia are the most common presenting symptoms. Diagnosis: History and physical exam suggest the diagnosis. An ultrasound should be performed to assess for retained products or if an abscess is suspected and cervical cultures should be obtained. Treatment: Broad-spectrum intravenous antibiotics such as ampicillinsulbactam, ticarcillin-clavulanate, pipercillin-tazobactam, or clindamycin with gentamycin.

E N DOM E T R I T I S

Definition: An infection of the breast tissue frequently seen in nursing mothers.

Etiology: Staphylococcus aureus is the most common etiology.

Clinical Presentation: Mastitis presents as fever, erythema, localized swelling and tenderness in the breast tissue, and typically occurs in the first month of nursing.
Diagnosis: History and physical exam suggest the diagnosis. Fineneedle aspiration or ultrasound can confirm the presence of an abscess. Treatment: Dicloxacillin 500 mg qid for 1 week or a first generation cephalosporin are first-line therapy. Incision and drainage should be performed if there is an abscess. In most cases, it is safe to continue nursing.

MAS T I T I S

CATEGORY
A Controlled studies show no risk B No evidence of risk in humans C Risk cannot be ruled out D Positive evidence of risk X Contraindicated in pregnancy

FDA RISK CATEGORIES

MEDICATION

COMMENTS

Isotretinoin CNS malformations, microtia, micrognathia, cleft palate, cardiac defects Misoprostol Abortion, Mobius syndrome, amniotic bands, multiple congenital anomalies Methotrexate Embryopathy, craniofacial defects, skeletal defects Warfarin IUGR, nasal hypoplasia, stippled epiphysis, vertebral abnormalities, fetal bleeding Ergotamines Vascular disruption, uterine contractions ACE Inhibitor Renal failure, oligohydramnios, fetal death Nitroprusside sodium Risk of cyanide poisoning to the fetus Quinolone Arthopathies

DRUGS CONTRAINDICATED IN PREGNANCY

MEDICATION

COMMENTS

Tetracycline (NSAID)

Discoloration of teeth Premature closure of the ductus arteriosus, oligohydramnios Antiepileptic drug Congenital heart disease, orofacial clefts, midfacial hypoplasia, neural tube defects Streptomycin Sensorineural deafness Lindane Neurotoxicity Ketoconazole (oral or IV) Interferes with steroid hormone production Amiodarone Neonatal thyroid dysfunction

DRUGS CONTRAINDICATED IN PREGNANCY