Clinical Diagnosis of

pregnancy
Dr. Archana vikram
Asst Prof
Objectives

 At the end of the session will be

able to:
• Diagnose pregnancy from
symptoms and signs.
• Calculate the gestational age.
• Define important terms related
to pregnancy.
Diagnosis of pregnancy

• Symptoms
• Signs
Symptoms of pregnancy
first trimester (12 weeks)
• Cessation of menstruation/
amenorrhoea
• Morning sickness
• Breasts discomfort- (6-8wks)
• Fatigue
• Increase in frequency of
micturation(8-12weeks)
• Breast;
Signs of pregnancy
Fullness, primary areola pigmentation,
Montgomery's tubercles( hypertrophied
sebaceous glands), reliable sign in
Primigravida. Colostrum(12 wks)

• Abdomen;
 Palpation, uterus palpable at 12 weeks of
gestation
 Vaginal examination

• Vaginal mucosa;
Jacquermin’s sign- vestibule and ant vaginal
wall
Dark Bluish colouration Chadwick’s sign(8 wk)
• Osiander sign- pulsations in lat fornix(8 wk)
• Goodells sign- soft cervix(6 wk)
• Leukorrhea, increase in vaginal discharge(6
wk)
 Uterine signs
• Size-egg(6 wk), cricket ball(8 wk), fetal
head(12 wk)
• Pisckacek sign-lat implantation n
asymmetrical enlargement
• Hegar’s sign of pregnancy(6-10wk)
Bimanual palpation of soft uterine isthmus
between the cervix and the body.
Palmar sign-(4-8wk)rhythmic and regular
contraction
Soft n elastic-Cystic sensation of uterus by
8 weeks
Hegar’s sign
Second trimester(13-
28wks) symptoms
• Quickening
• Progressive enlargement of
lower abdomen
signs
• Face;(24 wks)
Brown pigmentation, mask usually patchy
(Cholasma)
• Breast changes-prominent veins, sec
areolar(20 wk), montgomery tubercles,
colostrum –thick n yellow
• Abdomen
 Linea nigra, brown or black pigmentation-
stretching of collagen and elastin.
 Striae gravidarum, stretch marks, red or
purple during pregnancy, turns on to
white after pregnancy. Situated in the
lower abdomen, breasts, thighs, buttock.
Diagnosis of mid or
late pregnancy
Fetal movement (FM)
1) The first perception: in the
18th – 20th weeks
2) Diagnosis of pregnancy,
duration of pregnancy, the
safety of fetus
3) Count: 3 times per day, 1 hour
per time. sum×4= FM/12
hours. Normal:≥ 30/12 hours
Diagnosis of mid or
late pregnancy
Fetal heart tones
1) Heard: the 18th – 20th weeks
2) Normal rate: 120-160bpm
3) Differentiation: umbilical
souffle
Fetal body
Palpated: outlines of the
fetus (the 20th week).
External ballotment

• 20-28wks
Vaginal signs

• Bluish discoloration
• Internal ballotment(16-28wk)
Last trimester(29-40wk)

• symptoms-amenorrhoea,
enlargement of abdomen,
lightening,
frequency of micturation and fetal
movements.
SIGNS

• UTERINE shape- cylindrical to

spherical at 36wk
• Fundal height
• SFH
• Braxton hicks contractions
• Fetal movements
• Palpation of fetal parts, Liquor
• FHS
 Important terms
• Braxton Hicks contractions;
Occurs from first trimester painless spontaneous
irregular do not lead to labour
Lower uterine segment
The thin expanded lower portion of the uterus( the isthmus),
forms in the last trimester of pregnancy, after 32 weeks of
gestation. It provides the usual method of approach to deliver
the baby during Caesarean section (CS).
Lightening
Usually occurs after 36 weeks, more in primigravida.
Mother notices that it is easier to breath.
Differential dignosis

• Pseudocyesis
• Cystic ovarian tumor
• Fibroid
• Encysted peritonitis
• Distended urinary bladder
Calculation of the gestational age
• Last menstrual period (LMP), regular,
irregular, on the combined oral
contraceptive pills, number of spontaneous
cycles, bleeding in early pregnancy.
• Expected date of delivery/ confinement
(EDD, EDC),
Estimated by regularity of periods, no
immediate past oral pills, no bleeding in
early pregnancy.
Naegle’s rule, add one year
subtract 3 months
add 7 days
Terms related to
pregnancy
• Term, It is a period of time . It
is not the same as EDD
• Preterm, before 37 completed
weeks of gestation
• Posterm, after 42 completed
weeks of getation
Thank you