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The Diagnosis of Pregnancy

Dr. Rohit Jain


M.D (ob/gyn)
Department of ob & gyn
B.J Medical College
The Whole Period of
Pregnancy Can Be Divided Into
Three Stages:
 The first trimester (early pregnancy): 1-12w
 The second trimester (middle pregnancy): 13-
27 w
 The third trimester (late pregnancy): 28-40w
The Diagnosis of the First Trimester

1.History and symptoms


A. Cessation of menstruation
This is the first frequent symptom of
pregnancy, although a few women may
have slight bleeding after conception. But
amenorrhea is not only due to pregnancy
but also other reasons. Women of breast
feeding may be pregnant before the
recovery of menses.
1.The history and symptoms

 B. Nausea and vomiting

Also called morning sickness because they


occur upon arising. These symptoms
appear one or two weeks after the period
is missed and last until 10th to 12th week, its
severity varies from mild nausea to
persistent vomiting (e.g. Hyperemesis
gravidarum).
1.The history and symptoms

 C. Urinary symptoms

Increased frequency of urination is due to


increased circulation associated with the
effect of estrogen and progesterone on
the bladder, combined with pressure by
the gradually enlarged uterus on the
bladder.
Internal genital organs
1.The history and symptoms

D. Mastodynia
It may be present in early pregnancy
and ranges in severity from a
tingling sensation to frank pain.
2. Signs
Breast changes

Breast enlargement and vascular


engorgement. Nipple and areola
become blacker. Enlargement of the
accumulated sebaceous glands of the
areolas (Montgomery’s tubercles)
may be noted.
Fig.20-1 Breast changes. Montgomery’s glands are prominent,
and nipples and areolae are deeply pigmented. Accessory nipple
beneath left breast is also pigmented.
Changes of the reproductive organs

Vagina: The vaginal wall become


discoloration as the pelvic blood
vessel becomes congested.
(Chadwick’s sign)
Cervix: Cyanosis and a gradual

softening due to congestion.


(Goodell’s sign)
Changes of the reproductive organs

Uterus: enlargement and softening.


The isthmus of the uterus is also soft
and can be compressed between the
fingers palpating vagina and
abdomen (Hegar’s sign). After the
12th week, the fundus of the uterus is
usually palpable above the
symphysis pubis.
C. Supplementary examination
Pregnancy test
The laboratory test for pregnancy
are based on the identification of
human chorionic gonadotropin
(hCG), which can be detected as
early as 7-9 days after fertilization
by high sensitive technique. The
samples may be blood or urine.
Pregnancy test
Basal body temperature (BBT)

A persistent elevation of BBT for


longer than 18 days may be
presumptive evidence of
pregnancy.
Progesterone test
Progesterone is given to a women

with amenorrhea. If she is pregnant,


no bleeding will follow, otherwise,
bleeding should occur within 7-10
days of progesterone administration.
This is reliable in the nonpregnant
patient only if there is adequate
estrogen stimulation of the
endometrium.
cervical mucus

The cervical mucus smear of


pregnant women shows a


progestational effect—that is
ellipsoid instead of fern
crystallization.
cervical mucous       
(1) typeⅠ ( +++ ) : typical fern crystallization (2) typeⅡ ( ++ ) :
fern crystallization (3) type Ⅲ( + ) : atypical fern crystallization  
(4) type Ⅳ ( - ) : ellipsoid
Ultrasonography
There are trans-vaginal and
abdominal Ultrasonagraphys.
A gestational sac can usually be

identified at 5-6 weeks after the


beginning of the last period.
Ultrasonography
Fetal heart beating can be detected
by about 7th week and the fetus
itself can be seen by about the 8th
week.
Doppler is also an ultrasound
technique, which diagnoses the
pregnancy by revealing the heart
beating.
Picture of gestational sac
Picture of normal fetus
a . Pregnancy of 8w ; b . Pregnancy of 18w
BL-bladder ; UT-uterus ; GS-gestational sac
The diagnosis of the second and the
third trimester pregnancy

Symptoms
Abdominal enlargement and
fetal movement generally occurs
after the 18th to 20th week of
gestation.
Signs
The uterus continues to enlarge
Fetal movement (quickening)
can usually be seen or heard
after 18th week of gestation
Height of the uterine top

xiphoid
Signs
Fetal heart sound can be heard at
rate varies from 120 to 160 beats per
minute.
The fetal body can usually be
palpated by the 18th to 20th week of
gestation unless the patient is too fat,
the abdomen is tender or there is an
excessive amount of amniotic fluid.
Fetal heart
Fetal heart

(uterine souffle and umbilical souffle)


ballottement
Other Examinations
Ultrasonography.
X-ray. It is rarely used recently

because the harmfulness to the fetus.


Fetal electrocardiogram. A fetal

electrocardiogram can first be


recorded at about the 12th week of
pregnancy.
Fetal lie & fetal Presentation

Fetal lie: the relationship between


the long axis of the mother and the
long axis of the fetus. (longitudinal
lie and transverse lie)
Fetal presentation: the portion of the

fetus that descends into pelvis first.


fetal position
Fetal position: the relationship of

some guiding point of fetal


presentation to a fined area of the
maternal pelvis. (LOA, left occipital
anterior)