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DIAGNOSIS OF PREGNANCY:

DEFINITION

Women may suspect pregnancy when they miss a menstrual


period and she feels different .Changes in the breasts can
occur as early as 5 to 6 weeks after conception. A correct date
for the last menstrual period (LMP) and for the date of
intercourse and a basal body temperature (BBT) record may be
of great valve in the accurate diagnosis of pregnancy.

DIAGNOSIS OF PREGNANCY: In the first trimester and early


second trimester, is based on a combination of presumptive
and a probable sign of pregnancy.Pregnancy is self-evident
later in gestation when the positive signs of pregnancy are
readily observed.

Presumptive signs of pregnancy of pregnancy are


maternal physiological changes, which the women
experiences and which, in most cases, indicate to her that
she is pregnant.
 Amenorrhoea
 Nausea and vomiting(morning sickness) from 4th -14th
week
 Tingling, tenseness, nodularity and enlargement of the
nipples around 3rd to 4th week.
 Increased frequency of micturition around 6th to 4th week.
 Fatigue
 Colour changes of breasts i.e. darkening of the nipples
and primary and secondary areolar change.
 Appearance of Montgomery’s tubercles.
 Continued elevation of BBT in the absence of an infection.
 Expression of colostrums from nipple
 Excessive salivation
 Quickening
 Skin pigmentation and conditions such as
chloasma,breast and abdominal striae and linen nigra
Probable signs of pregnancy are maternal physiological
changes other than presumptive signs, which are
detected upon examination and documented by the
examiner
 Enlargement of the uterus
 Change in shape of the uterus
 Presence of human chronic gonadotrophin in blood(4th
to 12th) and in urine (6th to 12th )–positive pregnancy
tests
 Hegar’s sign(the softening and compressibility of the
uterine isthmus between the 6th and 12th weeks of
pregnancy)
 Jacquemier’s sign/chadwicks sign and osianders sign
 Palpation of Braxton Hick’s contractions
 Balloatment of foetus
Positive signs are those directly attributable to the
foetus as detected and documented by the examiner.
 Visualization of foetus by ultrasound(6 week+)
 Visualization of foetus skeleton by x-ray(16 week)
 Foetal heart sounds by ultrasound
 Foetal heart sounds with fetoscope(20 week)
 Palpable foetal movements(22th week)
 Visible foetal movements
 Palpation of foetal parts

UTERINE ENLARGEMENT

Estrogen and progesterone are responsible for the


hypertrophy of the uterine wall during the early months of
pregnancy. Uterine enlargement is the result of a considerable
increase in the size and stretching of the muscle cells.

After the third month of pregnancy the uterine enlargement is


also due to the mechanical effect of inside pressure on the
uterine wall by the growing products of conception. The
resulting vascularity, congestion and edema most likely
account for the overall softening of the uterus.This along with
hypertrophy of the cervical glands, give rise to
chadwick’s/Jacquemier’s sign and Hegar’s sign.
The softness and compressibility of the uterine isthmus
(Hegar’s sign) has the effects of non-support to the enlarging
body of the uterus with its increasing heaviness in the
fundus.While the uterus is still a pelvic organ and causes the
fundus to press on the bladder resulting in urinary frequency.

Uterine enlargement contributes to two other maternal signs of


pregnancy-the Braxton Hicks contractions and abdominal
enlargement. Braxton Hick’s contractions are non-
rhythmic,sporadic,painless uterine contractions that start
about the sixth week of pregnancy. Abdominal enlargement
begins at the fourth month of pregnancy, as the uterus
becomes an abdominal organ. The abdomen is more prominent
when the women is standing than when she is supine.It is
noticeable in multipara than in primigravidas, because of the
loss of muscle tone of the abdominal wall,which was not
exercised back into shape after each previous pregnancy.

FETAL CONTRIBUTIONS TO THE DIAGNOSIS OF


PREGNANCY

The foetal heart starts beating at the sixth week and can
be heard by 20th week with a fetoscope during abdominal
examination of the mother. However, it can be heard
between 12th and 20th week with ultrasonic instruments.
Fetal heart tones must be differentiated from two other
sound-
(1) The uterine soufflé-a soft blowing and systolic murmur
heard low down at the sides of the uterus, best on the left
side. The sound is due to increase in blood flow through
the dilated uterine vessels and is synchronous with the
maternal pulse.
(2) The funic soufflé-the sound of blood rushing through
the umbilical arteries. It is a soft blowing murmur
synchronous with the foetal heart sounds

HORMONAL PREGNANCY TESTS


 Pregnancy tests are based on the production of chorionic
gonadotrophin by the syncytiotrophoblastic cells during
early pregnancy. Human chorionic gonadotrophin (HCG) is
secreted into the maternal bloodstream where it is
present in the plasma. It is then excreted in the mother’s
urine.
 These tests have been largely superseded by the
immunologic assays of HCG.The immunologic assays of
HCG test utilizes specific antisera, obtained from animals
(rabbits) in which antibody response to HCG has been
stimulated. It is based on the fact that HCG is a protein
and therefore antigenic. The antisera are mixed with urine
of the women suspected of being pregnant.
SUBMITTED TO: MS SUBHASHINI G

HOD OBG NURSING DEPARTMENT

P.I.O.N

SUBMITTED BY: MS DIMSEY.R MARAK

MSC NURSING 1ST YEAR

P.I.O.N