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Diagnosis of Early Pregnancy

Amenorrhea ;
Nausea with or without vomiting(morning sickness)
Urinary frequency and urgency;
Pain slightly in the breast,
0ther symputoms :Uterine bleeding
Hegar’s sign;
Helpful Examinations
A.Clinical test
B.Pelvic ultrasonography
C. Basal body temperature ( BBT )
D. Pregestin test
E. Cervical mucus examination
Differential diagnosis
A. Myomas
B. Ovarian tumor
C. Ectopic pregnancy
Diagnosis of the second and third Trimester
of pregnancy
A.Symputoms: Amenorrhea ;
Disturbance in urination;
Perception of fetal movement
B.Presumptive Signs:
Breast changes ;
Discoloration of the vaginal mucosa ;
Increased skin pigmentation and appearance of abdominal striae
C.Probable evidence of pregnancy:
Enlargement of the abdomen;
Chan ges in size,shape ,and consistency of the uterus;
Braxton Hicks Contraction ;
D.Positive signs of pregnancy:Fetal heart action
Fetal movement by sonography
Recongnition of the fetal in the uterus cavity by sonography

Helpful Examinations:
Clinical test;
Differential diagnosis of pregnancy:
Ovarian tumor

Other examinations:
fetal lie ;
fetal presentation ;
fetal position
Lecturer: Liu Wenhui
Sophie liu
The Department of Gynecology &
Obstetrics in Zhongnan Hospital
Early pregnancy

The second trimester and the

third trimester
 History
 Physical examination
 Laboratory tests
 Advice to paients
 Tests & precedures
 Nutrition in pregnancy
 Age ,ethnic background,occupation
 Onset of LMP and its normality,possible conception dates,bleeding
after LMP,medical history,all prior
pregnancies(duration,outcome,and complications),symptoms of
present pregnancy
 Use of drugs, alcohol,tobacco,caffeine,nutritional habits
 Family history of congenital anomalies and heritable disease
 History of childhood varicella
 Prior STDs or risks for HIV infection
 How to describe a woman’s gravidity
para x+y
x is the number of babies delivered (include
live birth, stillbirth)
y is the number of pregnancies the woman
has had(include ectopic pregnancies and
abortions prior to 24 weeks gestation)
孕 2 产 0 孕 38W 待产 (Chinese)
Physical examination
 Height,weight,blood pressure,general physical
 Abdominal and pelvic examination:
1.estimate uterine size or measure fundal height
2.evaluate bony pelvis for symmetry and
3.evaluate cervix for structural
4.detect fetal heart sounds by Doppler device
after 10 weeks
Laboratory tests
■ Urinalysis,complete blood count(RBC
HGB,WBC,PLT),blood group,RH
type,atypical antibody screening,HbsAg
■ HIV screening,cervical Pap smear
Advice to patients

■ prenatal visits
maintain a schedule of regular
prenatal visits:
0-28weeks every 4 weeks
28-36weeks every 2 weeks
36weeks on weekly
■ Diet a balanced diet containing the major food
2.take prenatal vatamins with iron and folic acid
3. expect to gain 10-15Kg. Do not diet to lose
weight during pregnancy
4.decrease caffeine intake to 0-1 cup of coffe
,tea, or cola daily
5.avoid eat raw or rare meat fresh fruits and vegetables and wash them
before eating
 Do not take medications
unless prescribed or
authorized by physician
 Abstain from
alcohol,tabacoo,and all
recreational drugs
Common drugs that are
teratogenic or fetotoxic
Tobacco smoking
■X –Rays and noxious
1.Avoid x-rays
2.inform physicians
3. Avoid chemical or radiation
4. Avoid handling cat and dog
■ Rest and activity
1.obtain adequate rest each day
2.abstain from strenous physical
work or activity
3. exercise regularly
4. Avoid exhausting or hazardous
■ Birth classes
enroll in a childbirth
preparation class well
before due date
Tests & procedures

Each vist:
weight,blood pressure, fundal
height,fetal heart rate, urine
specimen for protein and glucose,
health ,and nutrition

Confirm uterine size and

grouth;document fetal heart
tones;chorionic villus
 Genetic counseling for women 35 years
or older at EDC
 Those with a family history of
congenital anomalies, a previous child
with chromosomal abnormality,and so
 Perform aminocentesis

 Fetal ultrasound
examination to show
fetal anatomy in
greater detail

 Maternal serum AFP

testing and HCG to
screen fetal teratogenic
20-24 weeks
 Instructpatient in signs of preterm
labor and rupture of membranes

24-28 weeks
Screening for GDM(gestational
diabete mellitus)by a 50g glucose load
28-36 weeks

 Repeat the complete blood count to

evaluate for anemia of pregnancy
 Determination of fetal position and
presention(LOA or LOP)
 Antepartum fetal testing (NST,OCT)
36 weeks to delivery
 Repeat HIV testing ,cervical culture N
gonorrhoeae and chlamydia in at-risk
 Elective delivery piror to 37 weeks of
gestation should confirmation of fetal
lung maturity
Nutrition in pregnancy

balanced nutrient
weight normal
the healthy mum give birth to a
healthy baby
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
 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


Infrequent or scanty menstrual periods.


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

Excessive uterine bleeding at and between menstrual

 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.


Bacteria and yeast (Candida) commonly

cause this infection.

 vulv/o vulva vulvovaginitis


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.

 -tocia labor,birth dystocia

Oxy-means rapid.
Case 1
 Name : Mary Sex:Female
 Age :30 Occupation:Teacher
 She has married for one year,now She has following
problems:cessation of menstruation about 2 months,
Her appitite has declined for three weeks,she goes to
toilet every 2 hours in recent 3 weeks .
List her probably symptoms and signs .
Make a clinical diagnosis.
Make a clinical differential diagnosis for the
enlargrment of uterus.
Case 2
 Lili’s
menstruation has stopped for 38 weeeks .
She has a girl of 3 years old.this is her second
gestation.Now she feels the normal fetal
movement every day .Through examination ,
her weight is 70 Kg,
Bp 110/70 mmHg,FHR is 142 bpm,the height
of the uterus is 34 cm,the fetal’s occiput is in
the left anterior side of maternal.
Give the correct diagnosis
wish you :
Learn to learn ;
Learn to do ;
Learn to together ;
Learn to be.

—— 原香港中文大学校长金耀基