Diagnosis of pregnancy

Xiangying Lou,
Lou MD
Dept. of Gynecology & Obstetrics
The First Affiliated Hospital of Jinan University
E-mail: louxiangying@163.com
1
 Duration of Pregnancy

Gestational (or menstrual) age: 40 weeks, 280 days

Fertilization (or ovulatory) age: 38 weeks, 266 days

The period of gestation can be divided into three phases:

 First trimester: 12 weeks gestational age
 Second trimester: 12+1- 27+6 weeks of gestational age
 Third trimester: after 28 weeks of gestational age
LMP----------------I-------------------I------------------EDC
12w 28w
2
 Contents

 Symptoms of pregnancy
 Signs of pregnancy
 Special investigation
 Fetal lie, presentation, attitude and position
 Routine prenatal care

3
 Case
 A 32-year-old married woman, G0 P0 ( gravidity,
parity) complains of more than 50 days amenorrhea

 What is the likely diagnosis ?

1) Menstrual history
14y 4-5 days / 28-30 days Jan 03, 2022

4
 Symptoms
1. Amenorrhea: Cessation of menses
The first and the most important symptom

The abrupt cessation of menstruation in a healthy

reproductive-age woman (fairly reliable sign)

Why?

5
6
 Symptoms
1. Amenorrhea: Cessation of menses
The first and the most important symptom

The abrupt cessation of menstruation in a healthy

reproductive-age woman (fairly reliable sign)

Why?
Caused by increasing estrogen and progesterone levels
produced by the pregnant corpus luteum
Note: emotional tension, disturbances in the
hypothalamic-pituitary-ovarian axis, recent use of the
contraceptive pill
7
 Case
 A 32-year-old married woman, G0 P0 (gravidity,
parity) complains of more than 50 days amenorrhea

 What is the likely diagnosis ?

1) Menstrual history
14y 4-5 days / 28-30 days Jan 14, 2021
2) Any discomfort? (symptoms)
Morning sickness, breast tenderness

8
 Symptoms

2. Morning sickness: (Nausea and vomiting)

Fatigue, nausea, anorexia to repeated vomiting (the 6th week↑ →
the 12th week↓ )
The nausea probably results from rapidly rising serum levels of

estrogen and hCG

Extreme nausea and vomiting may be a sign of multiple gestation

or molar pregnancy

9
3. Bladder symptoms (Frequency of micturition)
Enlarging uterus pressure on the urinary bladder
Gradually diminishes after 12th week, as the uterus rises up into

the abdomen

10
4. Breast tenderness and heaviness
Enlargement, vascular engorgement, darkening of
Nipples

11
5. Fetal movement (FM)
“Quickening” (feeling of life) ------perception of active
fetal movement.
The first perception: in the 18th – 20th week in primigravidae
(2 weeks earlier for multiparae)

12
 Case

 What is the next diagnostic step ?

1. Sign
Physical examination – Obstetrical examination
Hegar sign (+), size of uterus big than normal

13
 Signs of pregnancy

1. Changes in skin:
Pigmented areas become more so: the nipples, external
genitalia and anal region;
Some fresh pigmentation appears on the face (chloasma) and

on the abdomen (linea nigra);

Striae gravidarum or stretch marks

14
Striae gravidarum in the
axilla and upper arms

Striae gravidarum in the abdomen

15
2. Changes in genital organs:
Discoloration of the vaginal mucosa: Chadwick sign appear dark-
bluish or purplish-red

Cervical signs: Cervix becomes soft as early as 6th week, the bluish
discoloration

16
 Hegar’s sign: Early pregnancy, the isthmus of uterus feels
extremely soft, that the cervix and the body of the uterus seem
to be separate organs

17
3. Enlargement of the uterus
 By 12th week, the uterus is palpable through abdominal wall
just above the symphysis pubis
 22-24th week, the uterine fundus reaches the umbilicus

 18-32th week, there is good correlation between the

gestational age of the fetus and the height of the uterine
fundus
Fundal height (cm) ≈ (Gestational months + 1) Χ 3
normally: -3~+3
Q: Gestational age = 28 weeks, fundal height=28cm
Is it normal?

18
 Fundal height in
different gestational age

Three markers
1. Symphysis pubis
2. Umbilicus
3. Ensiform cartilage

19
Fundal height

20
4. Palpation of fetus: Physical outlining of the fetus

21
5. Fetal heart sound (FHS)
 The fetal heart sound can be detected by :
 auscultation with a stethoscope by 18-20 weeks

 Doppler equipment by 14 weeks

 The normal fetal heart rate: 110-160 bpm

22
5. Fetal heart sound (FHS)

 Different souffle:
 Uterine souffle is synchronous with maternal pulse

 Funic or fetal souffle: sharp, whistling sound that is

synchronous with the fetal pulse

23
 Case
 What is the next diagnostic step ?
1. Sign
Physical examination – Obstetrical examination
Hegar sign (+), size of uterus big than normal
2. Special investigations
Urine pregnant test (+)
Ultrasonic examination

24
 Special investigations
1. Human Chorionic Gonadotropin (HCG)
Produced by the syncytiotrophoblast
1 day after implantation → Be detected
Pregnancy test: hCG (or β subunit) in urine or serum ( + )

25
2. Ultrasonography
Enlargement of uterus, Gestational sac, Embryo or fetal pulse

26
3. Increased basal body temperature (BBT):
Persistent elevation of basal body temperature over 18 days

27
4. Changes in cervical mucus
Fern pattern will not occur
Beaded pattern (progesterone action)

a fernlike pattern a beaded pattern

28
 Case
 What is the next diagnostic step ?
1. Sign
Physical examination – Obstetrical examination
Hegar sign (+), size of uterus big than normal
2. Special investigations
Urine pregnant test (+)
Ultrasonic examination
 What is her diagnosis?
G1P0, intrauterine pregnancy for 7 weeks, singleton

29
Symptoms and Signs

30
 Contents

 Symptoms of pregnancy
 Signs of pregnancy
 Special investigation
 Fetal lie, presentation, attitude and position
 Routine prenatal care

31
 Fetal Lie, Presentation, Attitude and Position

Fetal Lie
The relationship of the long axis of the fetus to the long
axis of the centralized uterus or maternal spine.
Longitudinal, oblique and transverse lie

32
33
34
Fetal Presentation
That portion of the fetal body that is either foremost
within the birth canal or in closest proximity to it.
Fetal head or breech presentation, or the shoulder

35
Fetal Attitude
The relation of the different parts of the fetus to one another is
called attitude of the fetus. flexion

36
Fetal Position
refers to the relationship of an arbitrarily chosen portion of the
fetal presenting part to the right or left side of the birth canal.

left occipital anterior LOA

37
left occipital posterior LOP

right occipital transverse ROT

38
Varieties positions of occiput presentation
In an occiput presentation, the presentation, position, and variety
may be abbreviated in clockwise fashion as:

39
Diagnosis of Fetal Presentation and Position
1. Abdominal palpation: Leopold Maneuvers

40
2. Vaginal examination
 Put two fingers into the vagina and feel the presenting part;
 Swept forward over the fetal head toward the maternal symphysis;
cross the sagittal suture and its course is delineated
 Ascertain the positions of the two fontanels ;
 Ascertain the position that the presenting part has descended into
the pelvis.

41
3. 3-D navigation
childbirth navigation-------help judge the fetal position
sonography----harmless √; radiography-----harmful ╳

42
 Contents

 Symptoms of pregnancy
 Signs of pregnancy
 Special investigation
 Fetal lie, presentation, attitude and position
 Routine prenatal care

43
Initial Prenatal Evaluation

44
45
In our hospital:
Ultrasound:
Early: 11-13+6
Down’s screening
Mid: Deformity screening
Term: the blood flow
Lab test:
Blood test
Blood type and Rh
Urine test
Liver, kidney function
Glucose tolerance test
Syphilis serology
HIV, Hepatitis B and C
Thyroid function
Thalassemia
G-6-PD (Glucose-6-phosphate
Dehydrogenase)
GBS
46
Down’s screening

Nuchal translucency thickness

Nasal bone

Tricuspid regurgitation

47
48
Deformity screening

49
50
 Turning the pyramid of pregnancy care

12w
16w
Specialist
care 12-34w 22w
24w 28w
36w
30w 32w 34w 36w
41w
37w 38w 39w 40w 41w

51
 Answer questions?
 Pregnant women:
1. When will the baby delivery? Estimated date of
delivery (Lmp: Jan/03/2022)
2. What should I do next ?
3. When should I come to visit doctor next time?

 Doctor:
1. What should I do as a doctor?
2. How to evaluate the fetal well-being?

52
 Learn the past,
research the present
and predict the future

Hippocrates 460 BC – 370 BC

Thank you

53