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词条 Pregnancy
释义

  1. Terminology

  2. Signs and symptoms

  3. Chronology

     Start of gestational age  Estimation of due date 

  4. Physiology

     Initiation  Development of embryo and fetus  Maternal changes  First trimester  Second trimester  Third trimester  Childbirth  Childbirth maturity stages  Postnatal period 

  5. Diagnosis

     Physical signs  Biomarkers  Ultrasound 

  6. Management

     Prenatal care  Nutrition  Weight gain  Medication  Recreational drugs  Exposure to toxins{{anchor|Exposure to environmental toxins}}  Sexual activity  Exercise  Sleep   Dental care   Flying 

  7. Complications

  8. Intercurrent diseases

  9. Medical imaging

  10. Epidemiology

  11. Society and culture

     Arts  Infertility  Abortion  Legal protection 

  12. References

  13. Further reading

  14. External links

{{about|pregnancy in humans|other mammals|Pregnancy (mammals)|fish|Pregnancy in fish}}{{pp-move-indef}}{{pp-semi-protected|small=yes}}{{Use dmy dates|date=December 2012}}{{Infobox medical condition (new)
| name = Pregnancy
| synonym = Gestation
| image = Pregnant_woman.jpg
| alt =
| caption = A pregnant woman
| field = Obstetrics, midwifery
| symptoms = Missed periods, tender breasts, nausea and vomiting, hunger, frequent urination[1]
| complications = Miscarriage, high blood pressure of pregnancy, gestational diabetes, iron-deficiency anemia, severe nausea and vomiting[2][3]
| onset =
| duration = ~40 weeks from the last menstrual period[4][5]
| causes = Sexual intercourse, assisted reproductive technology[6]
| risks =
| diagnosis = Pregnancy test[7]
| differential =
| prevention = Birth control, abortion[1]
| treatment = Prenatal care[9]
| medication = Folic acid, iron supplements[9][11]
| prognosis =
| frequency = 213 million (2012)[12]
| deaths = {{decrease}} 230,600 (2016)[13]
}}Pregnancy, also known as gestation, is the time during which one or more offspring develops inside a woman.[2] A multiple pregnancy involves more than one offspring, such as with twins.[3] Pregnancy can occur by sexual intercourse or assisted reproductive technology.[4] Childbirth typically occurs around 40 weeks from the last menstrual period (LMP).[2][5] This is just over nine months, where each month averages 31 days.[2][5] When measured from fertilization it is about 38 weeks.[5] An embryo is the developing offspring during the first eight weeks following fertilization, after which, the term fetus is used until birth.[5] Symptoms of early pregnancy may include missed periods, tender breasts, nausea and vomiting, hunger, and frequent urination.[6] Pregnancy may be confirmed with a pregnancy test.[7]

Pregnancy is typically divided into three trimesters.[2] The first trimester is from week one through 12 and includes conception, which is when the sperm fertilizes the egg.[2] 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.[2] During the first trimester, the possibility of miscarriage (natural death of embryo or fetus) is at its highest.[8] The second trimester is from week 13 through 28.[2] Around the middle of the second trimester, movement of the fetus may be felt.[2] At 28 weeks, more than 90% of babies can survive outside of the uterus if provided with high-quality medical care.[2] The third trimester is from 29 weeks through 40 weeks.[2]

Prenatal care improves pregnancy outcomes.[9] Prenatal care may include taking extra folic acid, avoiding drugs and alcohol, regular exercise, 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 among others.[10] In the ideal childbirth labor begins on its own when a woman is "at term.[11] Babies born before 37 weeks are "preterm" and at higher risk of health problems such as cerebral palsy.[2] Babies born between weeks 37 and 39 are considered "early term" while those born between weeks 39 and 41 are considered "full term".[2] Babies born between weeks 41 and 42 weeks are considered "late term" while after 42 week they are considered "post term".[2] Delivery before 39 weeks by labor induction or caesarean section is not recommended unless required for other medical reasons.[12]

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.[12] The number of pregnancies in women ages 15 to 44 is 133 per 1,000 women.[13] About 10% to 15% of recognized pregnancies end in miscarriage.[8] In 2016, complications of pregnancy resulted in 230,600 maternal deaths, down from 377,000 deaths in 1990.[14] Common causes include bleeding, infections, hypertensive diseases of pregnancy, obstructed labor, and complications associated with miscarriage, ectopic pregnancy, or elective abortion.[15] Globally, 44% of pregnancies are unplanned.[46] Over half (56%) of unplanned pregnancies are aborted.[16] Among unintended pregnancies in the United States, 60% of the women used birth control to some extent during the month pregnancy occurred.[17]

{{TOC limit|3}}

Terminology

Associated terms for pregnancy are gravid and parous. Gravidus and gravid come from the Latin for "heavy" and a pregnant female is sometimes referred to as a gravida.[18] Gravidity is a term used to describe the number of times that a female has been pregnant. Similarly, the term parity is used for the number of times that a female carries a pregnancy to a viable stage.[19] Twins and other multiple births are counted as one pregnancy and birth. A woman who has never been pregnant is referred to as a nulligravida. A woman who is (or has been only) pregnant for the first time is referred to as a primigravida,[20] and a woman in subsequent pregnancies as a multigravida or as multiparous.[18][21] Therefore, during a second pregnancy a woman would be described as gravida 2, para 1 and upon live delivery as gravida 2, para 2. In-progress pregnancies, abortions, miscarriages and/or stillbirths account for parity values being less than the gravida number. In the case of a multiple birth the gravida number and parity value are increased by one only. Women who have never carried a pregnancy achieving more than 20 weeks of gestation age are referred to as nulliparous.[22]

The terms preterm and postterm have largely replaced earlier terms of premature and postmature. Preterm and postterm are defined above, whereas premature and postmature have historical meaning and relate more to the infant's size and state of development rather than to the stage of pregnancy.[23][24]

Signs and symptoms

{{Main|Symptoms and discomforts of pregnancy}}{{Further|Complications of pregnancy}}

The usual symptoms and discomforts 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 symptoms and discomforts of pregnancy include:

  • Tiredness
  • Morning sickness
  • Constipation
  • Pelvic girdle pain
  • Back pain
  • Braxton Hicks contractions. Occasional, irregular, and often painless contractions that occur several times per day.
  • Peripheral edema 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.
  • Low blood pressure often caused by compression of both the inferior vena cava and the abdominal aorta (aortocaval compression syndrome).
  • Increased urinary frequency. A common complaint, caused by increased intravascular volume, elevated glomerular filtration rate, and compression of the bladder by the expanding uterus.
  • Urinary tract infection[25]
  • Varicose veins. Common complaint caused by relaxation of the venous smooth muscle and increased intravascular pressure.
  • Hemorrhoids (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.[26]
  • Regurgitation, heartburn, and nausea.
  • Stretch marks
  • Breast tenderness is common during the first trimester, and is more common in women who are pregnant at a young age.[27]

Chronology

The chronology of pregnancy is, unless otherwise specified, generally given as gestational age, where the starting point is the woman's last menstrual period (LMP), or the corresponding age of the gestation as estimated by a more accurate method if available. Sometimes, timing may also use the fertilization age which is the age of the embryo.

Start of gestational age

{{Main|Gestational age}}

According to American Congress of Obstetricians and Gynecologists, the main methods to calculate gestational age are:[28]

  • Directly calculating the days since the beginning of the last menstrual period.
  • Early obstetric ultrasound, 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.[28]
  • In case of in vitro fertilization, calculating days since oocyte retrieval or co-incubation and adding 14 days.[29]

Estimation of due date

{{Main|Estimated date of delivery}}

Due date estimation basically follows two steps:

  • Determination of which time point is to be used as origin for gestational age, as described in section above.
  • Adding the estimated gestational age at childbirth to the above time point. Childbirth on average occurs at a gestational age of 280 days (40 weeks), which is therefore often used as a standard estimation for individual pregnancies.[31] However, alternative durations as well as more individualized methods have also been suggested.
Naegele's rule is a standard way of calculating the due date for a pregnancy when assuming a gestational age of 280 days at childbirth. The rule estimates the expected date of delivery (EDD) by adding a year, subtracting three months, and adding seven days to the origin of gestational age. Alternatively there are mobile apps, which essentially always give consistent estimations compared to each other and correct for leap year, while pregnancy wheels made of paper can differ from each other by 7 days and generally do not correct for leap year.[32]

Furthermore, actual childbirth has only a certain probability of occurring within the limits of the estimated due date. A study of singleton live births came to the result that childbirth has a standard deviation of 14 days when gestational age is estimated by first trimester ultrasound, and 16 days when estimated directly by last menstrual period.[30]

Physiology

Initiation

{{See also|Human fertilization}}

Through an interplay of hormones that includes follicle stimulating hormone that stimulates folliculogenesis and oogenesis creates a mature egg cell, the female gamete. Fertilization is the event where the egg cell fuses with the male gamete, spermatozoon. After the point of fertilization, the fused product of the female and male gamete is referred to as a zygote or fertilized egg. The fusion of female and male gametes usually occurs following the act of sexual intercourse. Pregnancy rates for sexual intercourse are highest during the menstrual cycle time from some 5 days before until 1 to 2 days after ovulation.[33] Fertilization can also occur by assisted reproductive technology such as artificial insemination and in vitro fertilisation.

Fertilization (conception) is sometimes used as the initiation of pregnancy, with the derived age being termed fertilization age. Fertilization usually occurs about two weeks before the next expected menstrual period.

A third point in time is also considered by some people to be the true beginning of a pregnancy: This is time of implantation, when the future fetus attaches to the lining of the uterus. This is about a week to ten days after fertilization.[34]

Development of embryo and fetus

{{Main|Prenatal development|Human embryogenesis|Fetus}}

The sperm and the egg cell, which has been released from one of the female's two ovaries, unite in one of the two fallopian tubes. The fertilized egg, known as a zygote, then moves toward the uterus, a journey that can take up to a week to complete. Cell division begins approximately 24 to 36 hours after the female and male cells unite. Cell division continues at a rapid rate and the cells then develop into what is known as a blastocyst. The blastocyst arrives at the uterus and attaches to the uterine wall, a process known as implantation.

The development of the mass of cells that will become the infant is called embryogenesis during the first approximately ten weeks of gestation. During this time, cells begin to differentiate into the various body systems. The basic outlines of the organ, body, and nervous systems are established. By the end of the embryonic stage, the beginnings of features such as fingers, eyes, mouth, and ears become visible. Also during this time, there is development of structures important to the support of the embryo, including the placenta and umbilical cord. The placenta connects the developing embryo to the uterine wall to allow nutrient uptake, waste elimination, and gas exchange via the mother's blood supply. The umbilical cord is the connecting cord from the embryo or fetus to the placenta.

After about ten weeks of gestational age, the embryo becomes known as a fetus. At the beginning of the fetal stage, the risk of miscarriage decreases sharply.[35] At this stage, a fetus is about 30 mm (1.2 inches) in length, the heartbeat is seen via ultrasound, and the fetus makes involuntary motions.[36] During continued fetal development, the early body systems, and structures that were established in the embryonic stage continue to develop. Sex organs begin to appear during the third month of gestation. The fetus continues to grow in both weight and length, although the majority of the physical growth occurs in the last weeks of pregnancy.

Electrical brain activity is first detected between the fifth and sixth week of gestation. It is considered primitive neural activity rather than the beginning of conscious thought. Synapses begin forming at 17 weeks, and begin to multiply quickly at week 28 until 3 to 4 months after birth.[37]

Maternal changes

{{Main|Maternal physiological changes in pregnancy}}

During pregnancy, the woman undergoes many physiological changes, which are entirely normal, including behavioral, cardiovascular, hematologic, metabolic, renal, and respiratory changes. Increases in blood sugar, breathing, and cardiac output are all required. Levels of progesterone and oestrogens rise continually throughout pregnancy, suppressing the hypothalamic axis and therefore also the menstrual cycle.

The fetus is genetically different from the woman and can be viewed as an unusually successful allograft.[38] The main reason for this success is increased immune tolerance during pregnancy.[39] Immune tolerance is the concept that the body is able to not mount an immune system response against certain triggers.[38]

Pregnancy is typically broken into three periods, or trimesters, each of about three months.[40][41] Each trimester is defined as 14 weeks, for a total duration of 42 weeks, although the average duration of pregnancy is 40 weeks.[42]

First trimester

Minute ventilation increases by 40% in the first trimester.[43] The womb will grow to the size of a lemon by eight weeks. Many symptoms and discomforts of pregnancy like nausea and tender breasts appear in the first trimester.[44]

Second trimester

Weeks 13 to 28 of the pregnancy are called the second trimester. Most women feel more energized in this period, and begin to put on weight as the symptoms of morning sickness subside and eventually fade away. The uterus, the muscular organ that holds the developing fetus, can expand up to 20 times its normal size during pregnancy.

Although the fetus begins to move during the first trimester, it is not until the second trimester that movement, known as quickening, can be felt. This typically happens in the fourth month, more specifically in the 20th to 21st week, or by the 19th week if the woman has been pregnant before. It is common for some women not to feel the fetus move until much later. During the second trimester, most women begin to wear maternity clothes.

Third trimester

Final weight gain takes place, which is the most weight gain throughout the pregnancy. The woman's abdomen will transform in shape as it drops due to the fetus turning in a downward position ready for birth. During the second trimester, the woman's abdomen would have been upright, whereas in the third trimester it will drop down low. The fetus moves regularly, and is felt by the woman. Fetal movement can become strong and be disruptive to the woman. The woman's navel will sometimes become convex, "popping" out, due to the expanding abdomen.

Head engagement, where the fetal head descends into cephalic presentation, relieves pressure on the upper abdomen with renewed ease in breathing. It also severely reduces bladder capacity, and increases pressure on the pelvic floor and the rectum.

It is also during the third trimester that maternal activity and sleep positions may affect fetal development due to restricted blood flow. For instance, the enlarged uterus may impede blood flow by compressing the vena cava when lying flat, which is relieved by lying on the left side.[45]

Childbirth

{{Main|Childbirth}}

Childbirth, referred to as labor and delivery in the medical field, is the process whereby an infant is born.[81]

A woman is considered to be in labour when she begins experiencing regular uterine contractions, accompanied by changes of her cervix – primarily effacement and dilation. While childbirth is widely experienced as painful, some women do report painless labours, while others find that concentrating on the birth helps to quicken labour and lessen the sensations. Most births are successful vaginal births, but sometimes complications arise and a woman may undergo a cesarean section.

During the time immediately after birth, both the mother and the baby are hormonally cued to bond, the mother through the release of oxytocin, a hormone also released during breastfeeding. Studies show that skin-to-skin contact between a mother and her newborn immediately after birth is beneficial for both the mother and baby. A review done by the World Health Organization found that skin-to-skin contact between mothers and babies after birth reduces crying, improves mother–infant interaction, and helps mothers to breastfeed successfully. They recommend that neonates be allowed to bond with the mother during their first two hours after birth, the period that they tend to be more alert than in the following hours of early life.[46]

Childbirth maturity stages

{{Further|Preterm birth|Postterm pregnancy}}{{anchor|Term}}
Stages of pregnancy term
stage starts ends
Preterm[47]
-
 at 37 weeks
Early term[48] 37 weeks 39 weeks
Full term[48] 39 weeks 41 weeks
Late term[48] 41 weeks 42 weeks
Postterm[48] 42 weeks
-

In the ideal childbirth labor begins on its own when a woman is "at term".[11]

Events before completion of 37 weeks are considered preterm.[47] Preterm birth is associated with a range of complications and should be avoided if possible.[49]

Sometimes if a woman's water breaks or she has contractions before 39 weeks, birth is unavoidable.[48] However, spontaneous birth after 37 weeks is considered term and is not associated with the same risks of a pre-term birth.[50] Planned birth before 39 weeks by Caesarean section or labor induction, although "at term", results in an increased risk of complications.[51] This is from factors including underdeveloped lungs of newborns, infection due to underdeveloped immune system, feeding problems due to underdeveloped brain, and jaundice from underdeveloped liver.[52]

Babies born between 39 and 41 weeks gestation have better outcomes than babies born either before or after this range.[48] This special time period is called "full term".[48] Whenever possible, waiting for labor to begin on its own in this time period is best for the health of the mother and baby.[11] The decision to perform an induction must be made after weighing the risks and benefits, but is safer after 39 weeks.[11]

Events after 42 weeks are considered postterm.[48] When a pregnancy exceeds 42 weeks, the risk of complications for both the woman and the fetus increases significantly.[53][54] Therefore, in an otherwise uncomplicated pregnancy, obstetricians usually prefer to induce labour at some stage between 41 and 42 weeks.[55]

Postnatal period

{{Main|Postnatal}}

The postnatal period, also referred to as the puerperium, begins immediately after delivery and extends for about six weeks.[50] During this period, the mother's body begins the return to pre-pregnancy conditions that includes changes in hormone levels and uterus size.[50]

Diagnosis

The beginning of pregnancy may be detected either based on symptoms by the woman herself, or by using pregnancy tests. However, an important condition with serious health implications that is quite common is the denial of pregnancy by the pregnant woman. About one in 475 denials will last until around the 20th week of pregnancy. The proportion of cases of denial, persisting until delivery is about 1 in 2500.[56] Conversely, some non-pregnant women have a very strong belief that they are pregnant along with some of the physical changes.

In most cultures, pregnant women have a special status in society and receive particularly gentle care. At the same time, they are subject to expectations that may exert great psychological pressure, such as having to produce a son and heir. In many traditional societies, pregnancy must be preceded by marriage, on pain of ostracism of mother and (illegitimate) child.

Overall, pregnancy is accompanied by numerous customs that are often subject to ethnological research, often rooted in traditional medicine or religion. The baby shower is an example of a modern custom.

Pregnancy is an important topic in sociology of the family. The prospective child may preliminarily be placed into numerous social roles. The parents' relationship and the relation between parents and their surroundings are also affected.

A belly cast may be made during pregnancy as a keepsake.

Arts

{{Main|Pregnancy in art}}

Images of pregnant women, especially small figurines, were made in traditional cultures in many places and periods, though it is rarely one of the most common types of image. These include ceramic figures from some Pre-Columbian cultures, and a few figures from most of the ancient Mediterranean cultures. Many of these seem to be connected with fertility. Identifying whether such figures are actually meant to show pregnancy is often a problem, as well as understanding their role in the culture concerned.

Among the oldest surviving examples of the depiction of pregnancy are prehistoric figurines found across much of Eurasia and collectively known as Venus figurines. Some of these appear to be pregnant.

Due to the important role of the Mother of God in Christianity, the Western visual arts have a long tradition of depictions of pregnancy, especially in the biblical scene of the Visitation, and devotional images called a Madonna del Parto.[154]

The unhappy scene usually called Diana and Callisto, showing the moment of discovery of Callisto's forbidden pregnancy, is sometimes painted from the Renaissance onwards. Gradually, portraits of pregnant women began to appear, with a particular fashion for "pregnancy portraits" in elite portraiture of the years around 1600.

Pregnancy, and especially pregnancy of unmarried women, is also an important motif in literature. Notable examples include Hardy's Tess of the d'Urbervilles and Goethe's Faust.

Infertility

{{main|Infertility}}

Modern reproductive medicine offers many forms of assisted reproductive technology for couples who stay childless against their will, such as fertility medication, artificial insemination, in vitro fertilization and surrogacy.

Abortion

{{main|Abortion}}

An abortion is the termination of an embryo or fetus, either naturally or via medical methods.[155] When done electively, it is more often done within the first trimester than the second, and rarely in the third.[35] Not using contraception, contraceptive failure, poor family planning or rape can lead to undesired pregnancies. Legality of socially indicated abortions varies widely both internationally and through time. In most countries of Western Europe, abortions during the first trimester were a criminal offense a few decades ago{{when|date=January 2014}} but have since been legalized, sometimes subject to mandatory consultations. In Germany, for example, as of 2009 less than 3% of abortions had a medical indication.

Legal protection

Many countries have various legal regulations in place to protect pregnant women and their children. Maternity Protection Convention ensures that pregnant women are exempt from activities such as night shifts or carrying heavy stocks. Maternity leave typically provides paid leave from work during roughly the last trimester of pregnancy and for some time after birth. Notable extreme cases include Norway (8 months with full pay) and the United States (no paid leave at all except in some states). Moreover, many countries have laws against pregnancy discrimination.

In the United States, some actions that result in miscarriage or stillbirth are considered crimes. One law that does so is the federal Unborn Victims of Violence Act. In 2014, the American state of Tennessee passed a law which allows prosecutors to charge a woman with criminal assault if she uses illegal drugs during her pregnancy and her fetus or newborn is considered harmed as a result.[156]

References

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16. ^1 2 {{cite journal | vauthors = Bearak J, Popinchalk A, Alkema L, Sedgh G | title = Global, regional, and subregional trends in unintended pregnancy and its outcomes from 1990 to 2014: estimates from a Bayesian hierarchical model | journal = The Lancet. Global Health | volume = 6 | issue = 4 | pages = e380–e389 | date = April 2018 | pmid = 29519649 | pmc = 6055480 | doi = 10.1016/S2214-109X(18)30029-9 }}
17. ^{{cite book|first1=K Joseph |last1=Hurt |first2=Matthew W. |last2=Guile |first3=Jessica L. |last3=Bienstock |first4=Harold E. |last4=Fox |first5=Edward E. |last5=Wallach | name-list-format = vanc |title=The Johns Hopkins manual of gynecology and obstetrics|publisher=Wolters Kluwer Health / Lippincott Williams & Wilkins|location=Philadelphia|isbn=978-1-60547-433-5|pages=382|url=https://books.google.com/books?id=4Sg5sXyiBvkC&pg=PR232|edition=4th|date=2012-03-28}}
18. ^1 {{cite web |url=http://medical-dictionary.thefreedictionary.com/gravida |title=definition of gravida |access-date=17 January 2008 |publisher=The Free Dictionary}}
19. ^{{cite web|title=Gravidity and Parity Definitions (Implications in Risk Assessment)|url=https://patient.info/doctor/gravidity-and-parity-definitions-and-their-implications-in-risk-assessment|website=patient.info|deadurl=no|archive-url=https://web.archive.org/web/20161212152618/http://patient.info/doctor/gravidity-and-parity-definitions-and-their-implications-in-risk-assessment|archive-date=12 December 2016|df=dmy-all}}
20. ^{{cite-TMHP|Primipara}}, page 596.
21. ^{{cite web|title=Definition of nulligravida|url=http://medical.merriam-webster.com/medical/nulligravida|publisher=Merriam-Webster, Incorporated|access-date=9 March 2012|deadurl=yes|archive-url=https://web.archive.org/web/20080908010608/http://medical.merriam-webster.com/medical/nulligravida|archive-date=8 September 2008|df=dmy-all}}
22. ^{{cite web |url=http://www.medterms.com/script/main/art.asp?articlekey=15259 |title=Nulliparous definition |date=18 November 2000 |publisher=MedicineNet, Inc |deadurl=no |archive-url=https://web.archive.org/web/20090709225422/http://www.medterms.com/script/main/art.asp?articlekey=15259 |archive-date=9 July 2009 |df=dmy-all }}
23. ^{{cite web |url=http://www.medterms.com/script/main/art.asp?articlekey=11895 |title=Definition of Premature birth |access-date=16 January 2008 |publisher=Medicine.net |deadurl=no |archive-url=https://web.archive.org/web/20090709225826/http://www.medterms.com/script/main/art.asp?articlekey=11895 |archive-date=9 July 2009 |df=dmy-all }}
24. ^{{cite web |url=http://health.discovery.com/encyclopedias/illnesses.html?article=2728 |title=Premature Infant |access-date=16 January 2008 |author=Lama Rimawi, MD |date=22 September 2006 |work=Disease & Conditions Encyclopedia |publisher=Discovery Communications, LLC. |deadurl=no |archive-url=https://web.archive.org/web/20080119213709/http://health.discovery.com/encyclopedias/illnesses.html?article=2728 |archive-date=19 January 2008 |df=dmy-all }}
25. ^{{cite web|last=Merck|title=Urinary tract infections during pregnancy|url=http://www.merckmanuals.com/home/womens_health_issues/pregnancy_complicated_by_disease/urinary_tract_infections_during_pregnancy.html|work=Merck Manual Home Health Handbook|deadurl=no|archive-url=https://web.archive.org/web/20111110140608/http://www.merckmanuals.com/home/womens_health_issues/pregnancy_complicated_by_disease/urinary_tract_infections_during_pregnancy.html|archive-date=10 November 2011|df=dmy-all}}
26. ^{{cite journal | vauthors = Vazquez JC | title = Constipation, haemorrhoids, and heartburn in pregnancy | journal = BMJ Clinical Evidence | volume = 2010 | pages = 1411 | date = August 2010 | pmid = 21418682 | pmc = 3217736 }}
27. ^[https://www.nlm.nih.gov/medlineplus/ency/article/003152.htm MedlinePlus > Breast pain] {{webarchive|url=https://archive.is/20120805080233/http://www.nlm.nih.gov/medlineplus/ency/article/003152.htm |date=5 August 2012 }} Update Date: 31 December 2008. Updated by: David C. Dugdale, Susan Storck. Also reviewed by David Zieve.
28. ^1 Obstetric Data Definitions Issues and Rationale for Change – Gestational Age & Term {{webarchive|url=https://web.archive.org/web/20131106111500/http://www.acog.org/About_ACOG/ACOG_Departments/Patient_Safety_and_Quality_Improvement/~/media/Departments/Patient%20Safety%20and%20Quality%20Improvement/201213IssuesandRationale-GestationalAgeTerm.pdf |date=6 November 2013 }} from Patient Safety and Quality Improvement at American Congress of Obstetricians and Gynecologists. Created November 2012.
29. ^{{cite journal | vauthors = Tunón K, Eik-Nes SH, Grøttum P, Von Düring V, Kahn JA | title = Gestational age in pregnancies conceived after in vitro fertilization: a comparison between age assessed from oocyte retrieval, crown-rump length and biparietal diameter | journal = Ultrasound in Obstetrics & Gynecology | volume = 15 | issue = 1 | pages = 41–46 | date = January 2000 | pmid = 10776011 | pmc = | doi = 10.1046/j.1469-0705.2000.00004.x }}
30. ^1 {{cite journal | vauthors = Hoffman CS, Messer LC, Mendola P, Savitz DA, Herring AH, Hartmann KE | title = Comparison of gestational age at birth based on last menstrual period and ultrasound during the first trimester | journal = Paediatric and Perinatal Epidemiology | volume = 22 | issue = 6 | pages = 587–596 | date = November 2008 | pmid = 19000297 | doi = 10.1111/j.1365-3016.2008.00965.x | author5-link = Amy H. Herring }}
31. ^{{cite web|url=http://www.healthline.com/yodocontent/pregnancy/your-due-date.html|title=Calculating Your Due Date|publisher=Healthline Networks, Inc.|access-date=13 January 2010|deadurl=no|archive-url=https://web.archive.org/web/20091221092403/http://www.healthline.com/yodocontent/pregnancy/your-due-date.html|archive-date=21 December 2009|df=dmy-all}}
32. ^{{cite journal | vauthors = Chambliss LR, Clark SL | title = Paper gestational age wheels are generally inaccurate | journal = American Journal of Obstetrics and Gynecology | volume = 210 | issue = 2 | pages = 145.e1–4 | date = February 2014 | pmid = 24036402 | doi = 10.1016/j.ajog.2013.09.013 }}
33. ^{{cite book|title=Taking Charge of Your Fertility|last=Weschler|first=Toni| name-list-format = vanc |publisher=HarperCollins|year=2002|isbn=978-0-06-093764-5|edition=Revised|location=New York|pages=242, 374}}
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35. ^1 * Lennart Nilsson, A Child is Born 91 (1990): at eight weeks, "the danger of a miscarriage ... diminishes sharply."* "Women's Health Information {{webarchive|url=https://web.archive.org/web/20070430200911/http://www.womens-health.co.uk/miscarr.asp |date=30 April 2007 }}", Hearthstone Communications Limited: "The risk of miscarriage decreases dramatically after the 8th week as the weeks go by." Retrieved 2007-04-22.
36. ^{{cite book|last1=Kalverboer|first1=Alex Fedde|last2=Gramsbergen|first2=Albertus Arend| name-list-format = vanc |title=Handbook of Brain and Behaviour in Human Development|url=https://books.google.com/books?id=FzyPozUyKPkC&pg=RA1-PA416|date=1 January 2001|publisher=Springer|isbn=978-0-7923-6943-1|pages=1–|deadurl=no|archive-url=https://web.archive.org/web/20150919073812/https://books.google.com/books?id=FzyPozUyKPkC&pg=RA1-PA416|archive-date=19 September 2015|df=dmy-all}}
37. ^{{cite book|editor-last=Illes|editor-first=Judy| name-list-format = vanc |title=Neuroethics : defining the issues in theory, practice, and policy|year=2008|publisher=Oxford University Press|location=Oxford|isbn=978-0-19-856721-9|pages=142|url=https://books.google.com/books?id=m7USFu5Z0lQC&pg=PA142|edition=Repr.|deadurl=no|archive-url=https://web.archive.org/web/20150919015206/https://books.google.com/books?id=m7USFu5Z0lQC&pg=PA142|archive-date=19 September 2015|df=dmy-all}}
38. ^1 {{cite book |title=Immunology of pregnancy |doi=10.1007/0-387-34944-8 |publisher=Landes Bioscience/Eurekah.com; Springer Science+Business Media |date=2006 |location=Georgetown, Tex. : New York |isbn=978-0-387-34944-2 |series=Medical intelligence unit |editor-first=Gil |editor-last=Mor | name-list-format = vanc |pages=1–4}}
39. ^{{cite journal | vauthors = Williams Z | title = Inducing tolerance to pregnancy | journal = The New England Journal of Medicine | volume = 367 | issue = 12 | pages = 1159–1161 | date = September 2012 | pmid = 22992082 | pmc = 3644969 | doi = 10.1056/NEJMcibr1207279 }}
40. ^trimester {{webarchive|url=https://web.archive.org/web/20120627130638/http://www.collinsdictionary.com/dictionary/english/trimester |date=27 June 2012 }}. CollinsDictionary.com. Collins English Dictionary – Complete & Unabridged 11th Edition. Retrieved 26 November 2012.
41. ^thefreedictionary.com > trimester Citing* The American Heritage® Dictionary of the English Language, Fourth Edition, copyright 2000
42. ^Cunningham, et al., (2010). Williams Textbook of Obstetrics, chapter 8.
43. ^{{cite journal | vauthors = Campbell LA, Klocke RA | title = Implications for the pregnant patient | journal = American Journal of Respiratory and Critical Care Medicine | volume = 163 | issue = 5 | pages = 1051–1054 | date = April 2001 | pmid = 11316633 | doi = 10.1164/ajrccm.163.5.16353 }}
44. ^{{cite web |url=http://www.nhs.uk/conditions/pregnancy-and-baby/pages/pregnancy-weeks-4-5-6-7-8.aspx#close |title=Your baby at 0–8 weeks pregnancy – Pregnancy and baby guide – NHS Choices |work=www.nhs.uk |deadurl=no |archive-url=https://web.archive.org/web/20131120025033/http://www.nhs.uk/conditions/pregnancy-and-baby/pages/pregnancy-weeks-4-5-6-7-8.aspx#close |archive-date=20 November 2013 |df=dmy-all |date=2017-12-20 }}
45. ^{{cite journal | vauthors = Stacey T, Thompson JM, Mitchell EA, Ekeroma AJ, Zuccollo JM, McCowan LM | title = Association between maternal sleep practices and risk of late stillbirth: a case-control study | journal = BMJ | volume = 342 | pages = d3403 | date = June 2011 | pmid = 21673002 | pmc = 3114953 | doi = 10.1136/bmj.d3403 }}
46. ^{{cite web|url=http://apps.who.int/rhl/newborn/gpcom/en/index.html|title=RHL|website=apps.who.int|deadurl=no|archive-url=https://web.archive.org/web/20111227074038/http://apps.who.int/rhl/newborn/gpcom/en/index.html|archive-date=27 December 2011|df=dmy-all}}
47. ^1 {{cite web |url=http://www.who.int/mediacentre/factsheets/fs363/en/ |title=Preterm birth |author=World Health Organization |work=who.int |date=November 2013 |access-date=19 September 2014 |deadurl=no |archive-url=https://web.archive.org/web/20140907152746/http://www.who.int/mediacentre/factsheets/fs363/en/ |archive-date=7 September 2014 |df=dmy-all }}
48. ^1 2 3 4 5 6 7 {{cite web |url=http://www.acog.org/About-ACOG/News-Room/News-Releases/2013/Ob-Gyns-Redefine-Meaning-of-Term-Pregnancy |title=Ob-Gyns Redefine Meaning of 'Term Pregnancy' |author1=American Congress of Obstetricians and Gynecologists |authorlink1=American Congress of Obstetricians and Gynecologists |author2=Society for Maternal-Fetal Medicine |authorlink2=Society for Maternal-Fetal Medicine |work=acog.org |date=October 22, 2013 |access-date=19 September 2014 |deadurl=yes |archive-url=https://web.archive.org/web/20140915035035/http://www.acog.org/About-ACOG/News-Room/News-Releases/2013/Ob-Gyns-Redefine-Meaning-of-Term-Pregnancy |archive-date=15 September 2014 |df=dmy-all }}
49. ^{{cite journal | vauthors = Saigal S, Doyle LW | title = An overview of mortality and sequelae of preterm birth from infancy to adulthood | journal = Lancet | volume = 371 | issue = 9608 | pages = 261–269 | date = January 2008 | pmid = 18207020 | doi = 10.1016/S0140-6736(08)60136-1 }}
50. ^1 2 3 4 5 6 7 8 9 10 11 {{cite book |edition = 24th|title = Williams obstetrics|chapter-url = http://ucsfcat.library.ucsf.edu/record=b2124757~S0|publisher = McGraw-Hill Education|date = 2014|location = New York|editor-first = F. Gary|editor-last = Cunningham|editor-first2 = Kenneth J.|editor-last2 = Leveno|editor-first3 = Steven L.|editor-last3 = Bloom|editor-first4 = Catherine Y.|editor-last4 = Spong|editor-first5 = Jodi S.|editor-last5 = Dashe|editor-first6 = Barbara L. |editor-last6 = Hoffman|editor-first7 = Brian M.|editor-last7 = Casey|editor-first8 = Jeanne S.|editor-last8 = Sheffield | name-list-format = vanc |chapter = Chapter 12. Teratology, Teratogens, and Fetotoxic Agents}}
51. ^{{Citation |author1=American Congress of Obstetricians and Gynecologists |author1-link=American Congress of Obstetricians and Gynecologists |date=February 2013 |title=Five Things Physicians and Patients Should Question |publisher=American Congress of Obstetricians and Gynecologists |work=Choosing Wisely: an initiative of the ABIM Foundation |page= |url=http://www.choosingwisely.org/doctor-patient-lists/american-college-of-obstetricians-and-gynecologists/ |access-date=August 1, 2013 |deadurl=no |archive-url=https://web.archive.org/web/20130901094916/http://www.choosingwisely.org/doctor-patient-lists/american-college-of-obstetricians-and-gynecologists/ |archive-date=1 September 2013 |df=dmy-all }}, which cites* {{Citation |last1=Main |first1=Elliott |last2=Oshiro |first2=Bryan |last3=Chagolla |first3=Brenda |last4=Bingham |first4=Debra |last5=Dang-Kilduff |first5=Leona |last6=Kowalewski |first6=Leslie | name-list-format = vanc |year= |title=Elimination of Non-medically Indicated (Elective) Deliveries Before 39 Weeks Gestational Age |publisher=March of Dimes; California Maternal Quality Care Collaborative; Maternal, Child and Adolescent Health Division; Center for Family Health; California Department of Public Health |location= |page= |url=http://www.cdph.ca.gov/programs/mcah/Documents/MCAH-EliminationOfNon-MedicallyIndicatedDeliveries.pdf |access-date=1 August 2013 |deadurl=yes |archive-url=https://web.archive.org/web/20121110174951/http://www.cdph.ca.gov/programs/mcah/Documents/MCAH-EliminationOfNon-MedicallyIndicatedDeliveries.pdf |archive-date=10 November 2012 |df=dmy-all }}
52. ^{{cite web |url=https://www.npr.org/templates/transcript/transcript.php?storyId=138473097 |title=Doctors To Pregnant Women: Wait At Least 39 Weeks |work=All Things Considered |author=Michele Norris |authorlink=Michele Norris |access-date=20 August 2011 |date=18 July 2011 |deadurl=no |archive-url=https://web.archive.org/web/20110723081827/http://www.npr.org/templates/transcript/transcript.php?storyId=138473097 |archive-date=23 July 2011 |df=dmy-all }}
53. ^{{cite web |url=http://www.uptodate.com/contents/postterm-pregnancy-beyond-the-basics |title=Postterm Pregnancy (Beyond the Basics) |access-date=24 August 2012 |last=Norwitz |first=Errol R. | name-list-format = vanc |publisher=UpToDate, Inc. |deadurl=no |archive-url=https://web.archive.org/web/20121007020439/http://www.uptodate.com/contents/postterm-pregnancy-beyond-the-basics |archive-date=7 October 2012 |df=dmy-all }}
54. ^{{cite web |url=http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZRDLPH97C&sub_cat=2005 |archive-url=https://web.archive.org/web/20030429020622/http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZRDLPH97C&sub_cat=2005 |dead-url=yes |archive-date=2003-04-29 |title=What To Expect After Your Due Date |access-date=16 January 2008 |author=The American College of Obstetricians and Gynecologists |date=April 2006 |work=Medem |publisher=Medem, Inc. }}
55. ^{{cite web |url=http://www.rcog.org.uk/resources/public/pdf/rcog_induction_of_labour.pdf |title=Induction of labour – Evidence-based Clinical Guideline Number 9 |access-date=18 January 2008 |year=2001 |publisher=Royal College of Obstetricians and Gynaecologists |archive-url=https://web.archive.org/web/20061230063449/http://www.rcog.org.uk/resources/public/pdf/rcog_induction_of_labour.pdf |archive-date=30 December 2006}}
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57. ^ --> This condition is known as a false pregnancy.{{cite book|last=Gabbe|first=Steven| name-list-format = vanc |title=Obstetrics : normal and problem pregnancies|publisher=Elsevier/Saunders|location=Philadelphia|isbn=978-1-4377-1935-2|page=[https://books.google.com/books?id=-3ufSTqeb6cC&pg=PA1184 1184]|edition=6th|date=2012-01-01}}
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59. ^1 {{cite web | title = Early symptoms of pregnancy: What happens right away | url = http://www.mayoclinic.com/health/symptoms-of-pregnancy/PR00102 | publisher = Mayo Clinic | date = 22 February 2007 | access-date = 22 August 2007 | deadurl = no | archive-url = https://web.archive.org/web/20070914132824/http://www.mayoclinic.com/health/symptoms-of-pregnancy/PR00102 | archive-date = 14 September 2007 | df = dmy-all }}
60. ^1 {{cite web |url=http://www.americanpregnancy.org/gettingpregnant/earlypregnancysymptoms.html |title=Pregnancy Symptoms – Early Signs of Pregnancy : American Pregnancy Association |access-date=16 January 2008 |deadurl=no |archive-url=https://web.archive.org/web/20080115221928/http://www.americanpregnancy.org/gettingpregnant/earlypregnancysymptoms.html |archive-date=15 January 2008 |df=dmy-all }}
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139. ^1 2 {{cite book |last1=Jarvis |first1=Sarah |last2=Stone |first2=Joanne |last3=Eddleman |first3=Keith |last4=Duenwald |first4=Mary |title=Pregnancy For Dummies |date=2011 |publisher=John Wiley & Sons |isbn=9781119997061 |page=157 |url=https://books.google.se/books?id=YaVwrjpeRZsC&pg=PT57 |language=en}}
140. ^{{cite web|url=https://www.tsa.gov/blog/2014/07/22/tsa-travel-tips-pregnant-passengers|title=TSA Travel Tips for Pregnant Passengers|date=2014-07-22|website=Transportation Security Administration}}
141. ^{{cite web|url=http://www.searo.who.int/EN/Section13/Section36/Section129/Section396_1450.htm|title=Reproductive Health and Research Publications: Making Pregnancy Safer|year=2009|publisher=World Health Organization Regional Office for South-East Asia|access-date=7 December 2009|deadurl=yes|archive-url=https://web.archive.org/web/20091215230752/http://www.searo.who.int/EN/Section13/Section36/Section129/Section396_1450.htm|archive-date=15 December 2009|df=dmy-all}}
142. ^{{cite web|last=Merck|title=Pregnancy complicated by disease|url=http://www.merckmanuals.com/home/womens_health_issues/pregnancy_complicated_by_disease/anemia_during_pregnancy.html|work=Merck Manual, Home Health Handbook|publisher=Merck Sharp & Dohme|deadurl=no|archive-url=https://web.archive.org/web/20111110141445/http://www.merckmanuals.com/home/womens_health_issues/pregnancy_complicated_by_disease/anemia_during_pregnancy.html|archive-date=10 November 2011|df=dmy-all}}
143. ^{{cite web|last=C. Blackwell|first=Sean| name-list-format = vanc |title=Thromboembolic Disorders During Pregnancy|url=http://www.merckmanuals.com/home/womens_health_issues/pregnancy_complicated_by_disease/thromboembolic_disorders_during_pregnancy.html|publisher=Merck Sharp & Dohme Corp|date=December 2008|deadurl=no|archive-url=https://web.archive.org/web/20111110135018/http://www.merckmanuals.com/home/womens_health_issues/pregnancy_complicated_by_disease/thromboembolic_disorders_during_pregnancy.html|archive-date=10 November 2011|df=dmy-all}}
144. ^1 {{cite book | last = Leveno | first = Kenneth | name-list-format = vanc | title = Williams manual of pregnancy complications | publisher = McGraw-Hill Medical | location = New York | year = 2013 |chapter=52|pages=323–334| isbn = 978-0-07-176562-6 }}
145. ^{{cite journal | vauthors = Tersigni C, Castellani R, de Waure C, Fattorossi A, De Spirito M, Gasbarrini A, Scambia G, Di Simone N | title = Celiac disease and reproductive disorders: meta-analysis of epidemiologic associations and potential pathogenic mechanisms | journal = Human Reproduction Update | volume = 20 | issue = 4 | pages = 582–593 | year = 2014 | pmid = 24619876 | doi = 10.1093/humupd/dmu007 | url = https://academic.oup.com/humupd/article-lookup/doi/10.1093/humupd/dmu007 | archive-url = https://web.archive.org/web/20170902170412/https://academic.oup.com/humupd/article-lookup/doi/10.1093/humupd/dmu007 | df = dmy-all | deadurl = no | archive-date = 2 September 2017 }}{{free access}}
146. ^{{cite journal | vauthors = Saccone G, Berghella V, Sarno L, Maruotti GM, Cetin I, Greco L, Khashan AS, McCarthy F, Martinelli D, Fortunato F, Martinelli P | title = Celiac disease and obstetric complications: a systematic review and metaanalysis | journal = American Journal of Obstetrics and Gynecology | volume = 214 | issue = 2 | pages = 225–234 | date = February 2016 | pmid = 26432464 | doi = 10.1016/j.ajog.2015.09.080 }}
147. ^{{cite web|title=The Gluten Connection|url=https://www.canada.ca/en/health-canada/services/food-nutrition/reports-publications/food-safety/celiac-disease-gluten-connection-1.html|publisher=Health Canada|access-date=1 October 2013|deadurl=no|archive-url=https://web.archive.org/web/20170705183625/https://www.canada.ca/en/health-canada/services/food-nutrition/reports-publications/food-safety/celiac-disease-gluten-connection-1.html|archive-date=5 July 2017|df=dmy-all|date=May 2009}}
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149. ^1 2 {{cite web|url=https://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Guidelines-for-Diagnostic-Imaging-During-Pregnancy-and-Lactation|title=Guidelines for Diagnostic Imaging During Pregnancy and Lactation|website=American Congress of Obstetricians and Gynecologists|deadurl=no|archive-url=https://web.archive.org/web/20170730145349/https://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Guidelines-for-Diagnostic-Imaging-During-Pregnancy-and-Lactation|archive-date=30 July 2017|df=dmy-all}} February 2016
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153. ^{{cite news|last=Jayson|first=Sharon| name-list-format = vanc |title=Unplanned pregnancies in U.S. at 40 percent|url=http://www.physorg.com/news/2011-05-unplanned-pregnancies-percent.html|newspaper=PhysOrg.com|date=20 May 2011|deadurl=no|archive-url=https://web.archive.org/web/20120105113426/http://www.physorg.com/news/2011-05-unplanned-pregnancies-percent.html|archive-date=5 January 2012|df=dmy-all}}
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155. ^{{cite web|url=http://www.merriam-webster.com/dictionary/abortion|title=Abortion – Definition and More from the Free Merriam-Webster Dictionary|work=merriam-webster.com|access-date=2015-07-19|deadurl=no|archive-url=https://web.archive.org/web/20150428075715/http://www.merriam-webster.com/dictionary/abortion|archive-date=28 April 2015|df=dmy-all}}
156. ^{{cite web |url=http://www.salon.com/2014/04/30/tennessee_just_became_the_first_state_that_will_jail_women_for_their_pregnancy_outcomes/ |title=Tennessee just became the first state that will jail women for their pregnancy outcomes |author=Katie Mcdonough |date=April 30, 2014 |work=Salon |access-date=May 5, 2014 |deadurl=no |archive-url=https://web.archive.org/web/20140505061404/http://www.salon.com/2014/04/30/tennessee_just_became_the_first_state_that_will_jail_women_for_their_pregnancy_outcomes/ |archive-date=5 May 2014 |df=dmy-all }}

}}

Further reading

{{refbegin}}
  • {{cite web|title=Nutrition For The First Trimester Of Pregnancy|url=http://www.ideafit.com/fitness-library/nutrition-for-the-first-trimester-of-pregnancy|publisher=IDEA Health & Fitness Association|access-date=9 December 2013}}
  • {{cite journal | vauthors = Bothwell TH | title = Iron requirements in pregnancy and strategies to meet them | journal = The American Journal of Clinical Nutrition | volume = 72 | issue = 1 Suppl | pages = 257S–264S | date = July 2000 | pmid = 10871591 | doi = 10.1093/ajcn/72.1.257S }}
  • {{Cite journal | last = Stevens | first = Jacqueline | name-list-format = vanc | title = Pregnancy envy and the politics of compensatory masculinities | journal = Politics & Gender | volume = 1 | issue = 2 | pages = 265–296 | doi = 10.1017/S1743923X05050087 | date = June 2005 | ref = harv | citeseerx = 10.1.1.485.5791 }}
{{refend}}

External links

{{Medical condition classification and resources
| DiseasesDB = 10545
| ICD10 = O00-O99, {{ICD10|Z|33||z|30}}, {{ICD10|Z34}}, {{ICD10|Z35}}
| ICD9 = {{ICD9|650}}
| MedlinePlus =002398
| eMedicineSubj =article
| eMedicineTopic =259724
| MeshID =D011247
}}{{Commons category|Human pregnancy}}{{Wikiquote}}
  • {{dmoz|Health/Reproductive_Health/Pregnancy_and_Birth}}
  • Merck Manual Home Health Handbook – further details on the diseases, disorders, etc., which may complicate pregnancy.
  • Pregnancy care planner – NHS guide to having a baby including preconception, pregnancy, labor, and birth.
{{Pregnancy}}{{Pathology of pregnancy, childbirth and the puerperium}}{{Pediatric conditions originating in the perinatal period}}{{Reproductive health}}{{Reproductive physiology}}{{Humandevelopment}}{{Sex}}{{Human sexuality}}{{Authority control}}

8 : Birth control|Family|Fertility|Human female endocrine system|Human pregnancy|Obstetrics|RTT|Women's health
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