You are on page 1of 55

The Diagnosis of the

second and third


Trimester of pregnancy
Lecturer: Liu Wenhui
Sophie liu
The Department of Gynecology & Obstetrics in
Zhongnan Hospital
Contents
Intruction
Manifestions of the second and third trimester of pregnancy
Helpful examinations of the second and third trimester of pregnancy
Differential diagnosis of the second and third trimester of pregnancy
Fetal position ,Fetal presentation,Fetal lie
Objectives

Master the Symputoms and the presumptive and


positive Signs of the second and third trimester of
pregnancy
Master helpful examinations
Master Fetal position,Fetal presentation and Fetal
lie
Introduction
末次月经
(LMP)
预产期
(EDC)
Early
pregnancy
The third 早期妊娠
trimester 12 周
晚期妊娠 末

The second
trimester
27 周 中期妊娠

妊娠全过程为 40 周( 280 天) , 分 三
Early pregnancy

The second trimester and the

third trimester of pregnancy


The female
reproductive system
consists of organs
that provide a place
for the growth of the
embryo and the fetal
Manifestations of the
second and third
trimester of pregnancy
A.Symputoms

Amenorrhea :no
menstruation flow or
cessation of menstruation
Disturbance in urination
1.Begins about 6th week ,and disappears
about 12th week
2.Reappears near the end of pregnancy
Perception of fetal movement

Slight fluttering movements in the


abdomon, increase in intensity(Quickening
Noted about at 18th week
A milestone of the progress of pregnancy
Provide corroborative evidence in
establishing the duration of gestation
B.Presumptive Signs

Breast changes
(enlargement,
lactating in late
pregnancy)
Discoloration of the vaginal
mucosa

Dark bluish or purplish –red


and congested (Chadwick sign)
Not conductive
Increased skin pigmentation
and appearance of abdominal
striae
Not diagnostic of
pregnancy
With the ingestion of
estrogen –pregestin
contraceptives too
C.Probable evidence of
pregnancy
Enlargement of the
abdomen
From 12th week
,the uterus gradually
increases in size
until the end of the
pregnancy
Changes in size,shape ,and
consistency of the uterus

An average uterine
diameter of 8cm is
attained by 12
weeks
The body of the
uterus is almost
globular
Braxton Hicks Contraction

Painles contractions at irregular


intervals
Increase in number and amplitude
when the uterus is messaged
In the last few days of pregnancy ,the
frequency may increase ,preparedness
for labor
Ballotement

near Midpregnancy
Outline of the fetus

Method of abdominal palpation to Method of abdominal palpation to


determine fetal lie and location of back determine presentation part
Attention:Positive signs
of pregnancy
Fetal heart action
Fetal movement by sonography
Recongnition of the fetal in the uterus
cavity by sonography
Fetal heart action

a.120bpm-160bpm
b.as a double sound
resembling the tick
of a watch under a pillow
正常 快音
快音
快音 慢音
NST

OCT
ATTENTION !
The umblical cord souffle
The uterine souffle
Sounds from the fetal movement
Maternal pulse
Gurgling sounds produced by gas or
liquid propulsion through the maternal
intestine
Helpful
Examinations
Clinical test
Pregnancy test
Get a peak at about
8 to 10 weeks
Then declines slowly
and maintains low
level at about 100 to
130 days until
delivery
Ultrasonography

Detect FHR accurantly,


monitoring the baby,
Excluding
teratogens(malformation),
Diagnose Twins and so on,
Abnormal placenta and
aminofluid
Differential diagnosis
of pregnancy
Myomas(fibroids)
Belign tumor in the uterus
Changes of menstruation
Very firm and irregular
(Bimanual palpation 双合
诊)
Pregnancy test is negative
No fetal in the uterine cavity
Ovarian tumor
Pregnancy test is
negative
No fetal in the uterine
cavity
Found midline
,displacing the
nonpregnant uterus to
the side or posteriorly
Other examinations
fetal lie : relationship between the long
axis of the fetus and the long axis of the
uterus
longitudinal lie( 纵产式 )99.75%
transverse lie( 横产式 )0.25%

shoulder presentation
fetal presentation : the fetus part which
is presented to the pelvis.
Different fetal lies have different
presentation, for example: longitudinal
lie has head or breech presentation
头先露因胎头屈伸程度不同有四种先露
Head presentation has 4 different attitudes

occiput bregma brow face(mentum)


breech presentation

Complete breech Frank breech Footling breech


fetal position : The relationship between
denominator of fetus presentation and
maternal pelvic

Presentation: Denominator:

Flexed head Occiput


Face Mentum(chin)
breech sacrum
LOA (left occipito-anterior) ROA (right occipito-anterior)
LOT(left occipito-transverse) ROT(right occipito-transverse)
LOP(left occipito-posterior) ROP(right occipito-posterior)
Questions ?
Give the meanings of the following
terms
NST
OCT
Fetal position
Fetal presentation
Fetal lie
Quickening
Which manifestions are there in the
second and third trimester of
pregnancy ?
Which examinations are helpful to
diagnose the second and third trimester
of pregnancy?
References
F.Gary ,Norman F.Gant,et.al Williams
Obstetrics, 21th Edition, 20-30
Alan H. Decherney , Martin L.
Pernoll,Current Obstetrics
&Gynecologic Diagnosis
&Treatment,66-70
youforyour
Thank

attention!
Combining Forms
Combining Form meaning Terminology Meaning
amni/o amnion amniocentesis
amniotic fluid
Produced by fetal membranes and the fetus.
cervic/o cervix,neck endocervicitis
chori/o chorion choriogenesis
chorion/o chorionic
colp/o vagina colporrhaphy
colposcopy
culd/o cul-de-sac culdocentesis
Placement of a needle through the posterior wall of the vagina
with withdrawal of fluid for diagnostic purposes.
Combining Form meaning Terminology Meaning
men/o menses, amenorrhea

menstruation Absence of menses for 6


months or for longer than 3 of the patient’s normal menstrual
cycles.
dysmenorrhea

oligomenorrhea

Infrequent or scanty menstrual periods.


menorrhagia

Abnormally heavy or long menstrual


periods. Fibroids are a leading causes of menorrhagia.
Combining Form meaning Terminology Meaning
metr/o uterus metrorrhagia
metri/o Uterine bleeding other than caused by
menstruation.
menometrorrhagia

Excessive uterine bleeding at and between menstrual


periods.
endometriosis
my/o muscle myometrium
myom/o muscle tumor myomectomy

Removal of fibroids from the uterus.


nat/i birth neonatal
The first 4 weeks of life after birth.
obstetr/o midwife obstetric
Combining Form meaning Terminology Meaning
ov/o egg ovum

ovari/o ovary ovarian


salping/o fallopian tubes salpingectomy

uter/o uterus uterine prolapse

vagin/o vagina vaginal orifice

Orifice means opening.


Vaginitis

Bacteria and yeast (Candida) commonly


cause this infection.

vulv/o vulva vulvovaginitis


Suffixes

Suffix Meaning Terminology Meaning


-arche beginning menarche

-gravida pregnancy primigravida

A woman during her first


pregnancy (primi-means first). Gravida is
also used as a noun to describe a pregnancy
woman, and it may be followed by numbers
to indicate the number of
pregnancies(gravida 1,2,3)
Suffix Meaning Terminology Meaning
-parous to bear,bring primiparous

forth An adjective describing a woman


who has borne (delivered )at least one child. Para is also
used as a noun and may be followed by numbers to indicate
the number of deliveries after the 20th week of gestation
(para 1,2,3).

-rrhea discharge leucorrhea


This nonbloody vaginal discharge may be mucoid or purulent
(containing pus) and a sign of infection or cervicitis.
menorrhea

-tocia labor,birth dystocia

oxytocia

Oxy-means rapid.