The Pregnant Patient: Managing Common Acute Medical Problems

David S. Gregory, MD; Velyn Wu, MD; Preyasha Tuladhar, MD


Am Fam Physician. 2018;98(9):595-602. 

In This Article

General Considerations for Pregnant Patients

To ensure appropriate evaluation and treatment, an accurate calculation of the estimated gestational age is essential. Some symptoms are trimester-specific, whereas others (e.g., abdominal pain, vaginal bleeding) may present throughout the pregnancy (Table 2). Symptoms and signs may vary in importance depending on whether they are caused by pregnancy or are simply common acute findings that may be unrelated to the pregnancy.

Physiologic changes in pregnancy lead to predictable problems that may impact the patient's function and health, such as musculoskeletal aches and pains, nasal congestion, and nausea. Given the potential risks of some treatments to the fetus, as well as possible maternal adverse effects, the decision of whether and how to treat is based on benefits vs. potential harms.[2]

The U.S. Food and Drug Administration's new labeling system for safety of medications during pregnancy and breastfeeding no longer uses alphabetical ratings (A, B, C, D, and X) and provides more guidance on risks, including information based on gestational age and lactation and reproductive risks.[3,4] After identifying the risks and benefits of treatments, family physicians can engage in shared decision making with their pregnant patients. Table 3 summarizes the evaluation and treatment of common symptoms during pregnancy.[5–42]