pregnancy (gestation)

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Childbirth generally occurs ~ 38 weeks after conception or ~ 40 weeks from the last normal menstrual period.



* pulmonary edema is pathologic

Nephrology: (Renal)










* folic acid fortification of cereal grains prevents > 1300 neural tube defects annually[19]

* folic acid supplementation in high-risk pregnancy is only 37%[20]


  • a pregnant woman capable of decision making should be allowed to decline recommended medical or surgical interventions[32]
    • directed counseling is recommended, but do not try to coerce women into making a specific decision
    • attempt to understand context of the decision & acknowledge prognostic uncertainty
    • consider ethics consult experts if it may help resolve the conflict
  • no action should be taken against clinicians who decline to perform court-ordered interventions

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  1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 49-50, 619
  2. 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 2.20 Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2009, 2012, 2015, 2018, 2021
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    corresponding NGC guideline withdrawn Dec 2014
  6. 6.0 6.1 Negro R et al. Increased pregnancy loss rate in thyroid antibody negative women with TSH levels between 2.5 and 5.0 in the first trimester of pregnancy. J Clin Endocrinol Metab 2010 Sep; 95:E44 PMID:
  7. Managing Asthma During Pregnancy: Recommendations for Pharmacologic Treatment--Update 2004
  8. 8.0 8.1 8.2 Prescriber's Letter 18(12): 2011 Use of Influenza and Pertussis Vaccines in Pregnancy Detail-Document#: (subscription needed)
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  10. 10.0 10.1 Verhaegen J et al Accuracy of single progesterone test to predict early pregnancy outcome in women with pain or bleeding: meta-analysis of cohort studies BMJ 2012;345:e6077 <PubMed> PMID: <Internet>
  11. 11.0 11.1 11.2 The American College of Obstetrics and Gynecology Committee on Obstetric Practice. Number 548 Jan 2013 Weight Gain During Pregnancy
    Number 549 Jan 2013 Obesity in Pregnancy
  12. 12.0 12.1 Centers for Disease Control and Prevention Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccine (Tdap) in Pregnant Women Advisory Committee on Immunization Practices (ACIP), 2012 MMWR. Feb 22, 2013 / 62(07);131-135
  13. 13.0 13.1 Journal Watch: Women's Health. Feb 28, 2013 Massachusett's Medical Society
    Pasternak B et al. Ondansetron in pregnancy and risk of adverse fetal outcomes. N Engl J Med 2013 Feb 28; 368:814 <PubMed> PMID: <Internet>
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    Dodd JM et al Antenatal lifestyle advice for women who are overweight or obese: LIMIT randomised trial. BMJ 2014;348:g1285 <PubMed> PMID: <Internet>
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  15. 15.0 15.1 FDA News Release. June 10, 2014 FDA and EPA issue draft updated advice for fish consumption.
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  18. 18.0 18.1 18.2 Madhi SA et al Influenza Vaccination of Pregnant Women and Protection of Their Infants. N Engl J Med 2014; 371:918-931. September 4, 2014 <PubMed> PMID: <Internet>
  19. 19.0 19.1 Williams J et al Updated Estimates of Neural Tube Defects Prevented by Mandatory Folic Acid Fortification - United States, 1995-2011. MMWR Weekly. January 16, 2015 / 64(01);1-5
  20. 20.0 20.1 Arth A et al Supplement Use and Other Characteristics Among Pregnant Women with a Previous Pregnancy Affected by a Neural Tube Defect - United States, 1997-2009 MMWR Weekly. January 16, 2015 / 64(01);6-9
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  23. 23.0 23.1 FDA MedWatch Feb 22, 2011 Antipsychotic drugs: Class Labeling Change - Treatment During Pregnancy and Potential Risk to Newborns
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    Centers for Disease Control and Prevention (CDC) Pregnancy and Whooping Cough
  26. 26.0 26.1 American Congress of Obsetricians & Gynecologists (ACOG) Physical Activity and Exercise During Pregnancy and the Postpartum Period. Committee Opinion Number 650, December 2015
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    Reid IR Towards a trial-based definition of vitamin D deficiency. The Lancet Diabetes & Endocrinology. March 1, 2016 <PubMed> PMID: Free Article <Internet>
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  32. 32.0 32.1 American College of Obstetricians and Gynecologists (ACOG) Refusal of Medically Recommended Treatment During Pregnancy Committee Opinion Number 664, June 2016
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  39. 39.0 39.1 Anello J, Feinberg B, Heinegg J et al Opioid Use and Pregnancy Guidelines on opioid use during pregnancy by the American College of Obstetricians and Gynecologists. Medscape: New Guidelines and Recommendations, August 2017.
    American College of Obstetricians and Gynecologists (ACOG) Opioid Use and Opioid Use Disorder in Pregnancy. Committee Opinion Number 711, August 2017
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  43. California Maternal Quality Care Collaborative

Patient information

pregnancy patient information