Presented By- Baljeet Kaur

Diagnosis of pregnancy
The importance of the problem
• avoiding exposure to teratogens (e.g. drugs)
• solving abnormal situations (e.g. ectopic pregnancy,
hydatidiform mole)
• initial assessment and monitoring through prenatal care

• history
Diagnosis • clinical examination
• laboratory tests

The duration of pregnancy in humans

• 259 - 294 days =37-42 weeks
• medium= 280 days (40 weeks)

During the first half – maternal signs prezumptive diagnosis

During the second half – fetal signs diagnosis of certitude

 Diagnosis of pregnancy in the first 16 weeks
(I-st trimester)
History
• personal data
• family history
• general informations • personal medical history
• obstetrical history
• data about the partener
• contraceptive history

amenorheea increased E2 and P secretion by

luteal corpus

Conditions
• previous regular, spontaneous, predictible menstruations
• absence of menstruation for min. 10 days
 Diagnosis of pregnancy in the first 16 weeks
(I-st trimester)
• enlargement
 Breasts symptoms • heaviness or tension History
• mastodinia, tenderness

 Neuro-vegetative symptoms
• nausea ( over 50%) and vomiting
Digestive • sialoreea
• pyrozis
• alteration of apetite, taste, smell, food preferences

appeared during 4-6 weeks

disappeared spontaneously after 12-14 weeks
Urinary bladder irritability (compresion)

Nervous sleep difficulties, irritability, insomnia

Diagnosis of pregnancy in the first 16 weeks (I-st trimester)
Clinical signs
Inspection
 Breasts
- increase in size
- venous network (Haller)
- Montgomery tubercules (sebaceus glands)
- minute hyper-pigmentation of the areola and the nipple
 Abdomen
- linea nigra
- progressive deformation upward symfizis pubis (after 12
weeks)
 Perineum – accentuation of pigment
 Diagnosis of pregnancy in the first 16 weeks
(I-st trimester)
Clinical signs
Palpation
Breasts
- specific consistency
- colostrum (occasionally) – thick, yellowish fluid, expressed
from the nipples
Abdomen
- pregnant uterus – the upper margin of a globulous, soft
mass
- the height of the uterine fundus becomes measurable
(cm)
 Diagnosis of pregnancy in the first 16 weeks
(I-st trimester)
Clinical signs
Obstetrical examination
Cervix, vagina and perineum (speculum examination)
- increased vascularity and hyperemia
- characteristic violet-bluish color of the mucosa – Chadwick
sign
- increased size of the cervix
Uterus (bimanual examination)
- softening of the cervix, isthmus (Hegar sign) and uterine
corpus
- enlargement of the uterus (4cm per month)
- irregular, painless uterine contractions – Braxton-Hicks
contractions
 Diagnosis of pregnancy in the first 16 weeks
(I-st trimester)
Noble sign

Hegar Piscaceck
sign sign
 Diagnosis of pregnancy in the first 16 weeks
(I-st trimester)

Differential diagnosis
- abdominal mass: ovarian cyst, uterine myoma,
trophoblastic disease, ectopic pregnancy, bladder
globus
- amenorrhea: in the emotional stress, endocrine
disfunctions, lactation, anorexia, certain treatments
(e.g. antidepressants, metyldopa, haloperidol),
pseudocyesis
 Diagnosis of pregnancy in the first 16 weeks
(I-st trimester)
Laboratory diagnosis
Principle: presence of hCG in plasma and urine
- produced by syncytiotrophoblast
- peak at 60-70 days
- biological tests (laboratory animals)
- immunological tests – β-hCG (monoclonal anti-HCG
antibody serum assays); home test kit (ELISA, RIA, etc)
- detection and quantification
hCG in plasma and urine
 Diagnosis of pregnancy in the first 16 weeks
(I-st trimester)
Ultrasound imaging
- abdominal sonography
- vaginal sonography can detect an uterine pregnancy 1 week
after the missed menstruation
AIMS
- assessment of the amnionic sac dimensions (4-5 weeks)
- visualize the fetus and the placenta (position, aspect)
- measure fetal crown-rump length (FCR)
- detects twins, ectopic pregnancy, missed abortion,
hydatidiform mole.
Diagnosis of pregnancy in the first 4-5
weeks (I-st trimester)
Diagnosis of pregnancy between the 17- 28 weeks
(II-nd trimester)
Clinical signs
- amenorrhea (> 16 weeks)
- progressive enlargement of the abdomen
- perception of the fetal movements by the mother beginning with
17-18 weeks (multiparas) up to 19-20 weeks (primiparas) =
quickening
Inspection
Face: chloasma (melasma gravidarum) = mask of pregnancy
Breasts: increased vascularity, Montgomery tubercules, pigmented
primary areola and the nipple, secondary areola
 Abdomen: enlargement, linea nigra, stria (reddish, slightly
depressed streaks), protruded umbilicus, pigmented scars
Perineum – accentuation of pigment
Diagnosis of pregnancy between the 17- 28 weeks
(II-nd trimester)
Diagnosis of pregnancy between the 17- 28 weeks
(II-nd trimester)

Clinical signs
Palpation
Breasts: specific consistency, colostrum expressed from the
nipples
Abdomen:
- pregnant uterus – a globulous, soft, contractile, painless mass
- irregular, painless uterine contractions – Braxton-Hicks
contractions
- the height of the uterine fundus becomes measurable (16cm –
20 weeks, 20cm – 24 weeks)
- ballottement sign
Ascultation
fetal heart sounds (110-160 b/min), with obstetrical
stethoscope, near umbilicus
Diagnosis of pregnancy between the 17- 28 weeks
(II-nd trimester)
Diagnosis of pregnancy between the 17- 28 weeks
(II-nd trimester)
Clinical signs
Obstetrical examination – cont.
Speculum examination (cervix, vagina and perineum)
- hyperemia
- Chadwick sign (violet-bluish color of the mucosa)
- increased size of the cervix
Bimanual examination (uterus)
- softening of the vagina, cervix, lower segment and upper segment
- enlargement of the uterus
- Braxton-Hicks contractions
- vaginal ballottement
 Diagnosis of pregnancy between the 17- 28 weeks
(II-nd trimester)

Differential diagnosis
abdominal mass
ovarian cyst with abdominal development

uterine myoma
Diagnosis of pregnancy between the 17- 28 weeks
(II-nd trimester)

Laboratory diagnosis
- biological tests – no more
- immunological tests – β-hCG (detection and quantification)
Ultrasound imaging
abdominal sonography / vaginal sonography
AIMS
- gestational age (BPD, FL, AC)
- fetal morphology and biometry
- multiple pregnancy
- fetal heart movements
- placental insertion, a.f.
Diagnosis of pregnancy between the 29 - 40 weeks
(III-rd trimester)
Clinical signs
- amenorrhea (> 29 weeks)
- progressive enlargement of the abdomen
- perception of the fetal movements by the mother/examinator
Inspection
Face: chloasma (melasma gravidarum) = mask of pregnancy
Breasts: increased vascularity, Montgomery tubercules,
pigmented primary areola and the nipple, secondary areola
 Abdomen: enlargement, linea nigra, striae gravidarum,
protruded umbilicus, pigmented previous surgical scars
Perineum – accentuation of pigment
 Diagnosis of pregnancy between the 29 - 40 weeks
(III-rd trimester)
Clinical signs
Palpation
Breasts: specific consistency, colostrum expressed
from the nipples
Abdomen (Leopold manoevers):
Superficial palpation
- pregnant uterus (a globulous, soft, contractile, painless
mass, Braxton-Hicks contractions
- measurement of the height of the uterine fundus
Diagnosis of pregnancy between the 29 - 40 weeks
(III-rd trimester)
 Diagnosis of pregnancy between the 29 - 40 weeks
(III-rd trimester)
Clinical signs
Abdomen:
Deep palpation
- identification of the presenting part (if the head, it is firm,
rounded, large, regulated)
- lateral palpation – on the sides of the uterus (the back is an
elongated firm mass; the limbs are small, irregular parts)
Ascultation
fetal heart sounds (110-160 b/min) in vertex presentation –
below the umbilicus
Diagnosis of pregnancy between the 29 - 40 weeks
(III-rd trimester)
Diagnosis of pregnancy between the 29 - 40 weeks
(III-rd trimester)
Diagnosis of pregnancy between the 29 - 40 weeks
(III-rd trimester)

Clinical signs
Obstetrical examination
Speculum examination (cervix, vagina and perineum)
- hyperemia
- Chadwick sign (violet-bluish color of the mucosa)
- increased size of the cervix
- external cervical os - slit-like or round, with mucous plug
Bimanual examination
- softening of the vagina, cervix, lower segment and upper
segment (patulous cervix admits a fingertip)
- fetal presenting part, membranes
 Diagnosis of pregnancy between the 29 - 40 weeks
(III-rd trimester)

Ultrasound imaging
abdominal sonography / vaginal sonography
AIMS

- fetal morphology and biometry (BPD, Fl, AC)

- fetal heart movements,

- breathing movements
- evaluation of the amniotic fluid
- placental insertion and maturation degree
 Presumptive evidence of pregnancy
Subjective symptoms
- nausea +/- vomiting
- disturbances in urination
- fatigue
- the perceptions of fetal
movements
Presumptive signs
- cessation of menses
- changes in the breast
- changes in the cervical mucus
- discoloration of the vaginal
mucosa
- increased skin pigmentation and
development of abdominal
striae
- does the woman believe that
she is pregnant?
 Probable evidence of pregnancy
Enlargement of the abdomen

Changes in the shape, size and consistency of the uterus

Anatomical changes in the cervix

Braxton-Hicks contractions

Ballottement

Physical outlining of the fetus

Presence of β-hCG in serum or urine

 Positive signs of pregnancy
Identification of fetal heart activity separately and

distinctly (from mother)

Perception of fetal movements by the examiner

Recognition of the embryo / the fetus throughout

imagistic methods (ultrasound)

 Gestational age assessment
 First day of the last menstrual period (LMP) + no. of
weeks
 The day when the mother has felt the first fetal
movements (quickening) + 22 weeks in multiparas, or
20 weeks in primiparas
 The uterine height (UH) in cm + 4 =the number of
gestational weeks
 Ultrasound examination during the first 12 weeks of
amenorrhea