DIAGNOSIS OF PREGNANCY

PRIYANKA GEHLOT
M.Sc.Nursing Pre. Year
Batch 2019
Govt. College of Nursing,
jodhpur
 Introduction -
Antenatal diagnosis
of pregnancy
include –
1. Presumptive signs

2. Probable signs

3. Positive signs
 FIRST TRIMESTER(FIRST 12
WEEKS)

A. SUBJECTIVE SYMPTOMS -
AMENORRHOEA
MORNING SICKNESS(FIRST TRIMESTER)
FREQUENCY OF MICTURATION(8-12
WKS)
BREAST DISCOMFORT ( 6-8 WKS )
FATIGUE
B. OBJECTIVE SIGN
1. BREAST CHANGES (6-8WEEKS)

 Breast enlargement with vascular

engorgement.
 Nipple and areola become more
pigmented.
 Colostrum can be expressed as early as
12th week.
 Montgomery’s tubercles are prominent.
2. PELVIC CHANGES -
JACQUEMIER’S SIGN (8WKS)
OSIANDER SIGN
GOODELL’S SIGN
UTERINE SIGN
HEGAR’S SIGN
Uterus remains a pelvic organ until
12th week, then it may be felt per
abdomen as a suprapubic bulge.
i. CHADWICK’S SIGN -
ON SPECULUM INSPECTION –

CERVIX & VAGINA APPEAR

BLUISH OR PURPLISH
DISCOLORATION DUE TO

VASCULAR CONGESTION AT

ABOUT 8TH WEEK OF

PREGNANCY.
ii. OSIANDER’S SIGN ( vaginal signs )
BLUISH DISCOLOURATION OF THE
ANTERIOR VAGINAL WALL

COPIUS NON IRRITATING MUCOID

DISCHARGE APPEARS AT 6TH WEEK

INCREASE PULSATION FELT THROUGH

THE LATERAL FORNICES AT 8TH WK.
iii. GOODELL’S SIGN ( cervical
signs)
Appears at 6th week
iv. UTERINE SIGN -
HEN’S EGG 6TH WK

CRICKET BALL 8TH WK

FETAL HEAD 12 WK

SHAPE – BECOMES GLOBULAR AT 12

WKS FROM PYRIFORM.
CONSISTENCY – BECOMES SOFT &
ELASTIC.
v. HEGAR’S SIGN
(6-8WKS)
UPPER PART OF
THE BODY OF THE
UTERUS IS
ENLARGED BY
THE GROWING OVUM
LOWER PART OF
THE BODY IS EMPTY
AND EXTREMELY SOFT.
CERVIX IS COMPARATIVELY FIRM.
C. Immunological tests for diagnosis of
pregnancy
PREGNANCY TEST
SUMMARY OF PREGNANCY TEST

TEST SENSITIVIT TIME INFERENCE POSITIVE ON

Y HCG TAKEN
(IU/ML)
IMMUNOLOGICAL TEST 1.5-3.5 2MIN NO AGGLUTINATION 42 DAYS AFTER LMP
SLIDE TEST

BETA GRAVINDEX SLIDE 0.5-1 2MIN ABSENCE OF 2 DAYS AFTER MISSED

TEST AGGLUTINATION PERIODS

PREG COLOR TEST 1.5-2 0MIN TURNS COLOURLESS 2 DAYS AFTER MISSED
PERIODS
DIRECT LATEX 0.2 2MIN PRESENCE OF 2 -3DAYS AFTER MISSED
AGGLUTINATION TEST AGGLUTINATION PERIODS

ELISA 0.02-0.05 4-5MIN BLUE LINE IN THE 28TH DAYS OF CYCLE

CONTROL AS WELL AS
IN RESULT WINDOW
RAIOIMMUNOASSAY 0.002 3-4HRS 25TH DAY OF THE CYCLE

RADIO RECEPTOR ASSAY 0.001 1HR 22ND DAY OF CYCLE

Cont..
Time -8-11 days after conception. The test is not reliable
after 12 weeks.
Collection of urine -First voided urine in the morning in a
clean container.
Other uses of pregnancy tests
To Diagnosis of ectopic pregnancy
Monitoring pregnancy following IVF and embryo transfer
Follow-up of cases of hydatidiform mole and
choriocarcinoma.
Limitations - Test accuracy is affected due to presence of
haemoglobin, albumin, LH and immunological diseases.
Advantages - Speed, simplicity, accuracy and less cost.
D. ULTRA-SONOGRAPHY
SONOGRAPHY- gestational sac
identified on 29 to 35 days of gestation.
Cont…
FETAL VIABILITY IS DETERMINED BY DETECTING
THE FOLLOWING STRUCTURE BY TVS –
i. GESTATIONAL SAC AND YOLK SAC BY 5 WEEKS.
Cont…-
ii. FETAL POLE AND CARDIAC
ACTIVITY BY 6 WEEKS.
Cont...
EMBROYONIC MOVEMENTS BY 7 WEEKS
 Cont..
DOPPLER ULTRASOUND CAN PICK UP THE FETAL
HEART RATE RELIABLY BY 10TH WEEK.
FOETAL GESTATIONAL AGE IS BEST DETERMINED
BY MEASURING CRL BETWEEN 7-12 WEEKS.
Second trimester (13 to 28 weeks)
A. Subjective symptoms –
• Nausea, vomiting and frequency of
micturation usually subside.
• Quikening –
- between 18 to 20th weeks in primigravidae
- between 16 to 18th weeks in multigravidae

• Progressive enlargement of lower abdomen by

the growing uterus.
B. Objective signs -
General examination –
1. Face - ( At 24th weeks)
2. Breast changes-
More enlarged with prominent veins
under the skin.
Secondary areola appears at 20th weeks.
Montgomery’s tubercle are prominent
and extend to the secondary areola.
Colostrum becomes thick and yellowish
by 16th week.
Variable degree of striae may be visible
with advancing weeks.
•ABDOMINAL EXAMINATION -
a. INSPECTION
b. PALPATION
c. AUSCALTATION
•Abdominal examination-
a. Inspection –
• linea nigra becomes visible at 20th weeks.
• Striae (both pink & white) of varying degree are
visible in the lower abdomen.
b. Palpation -
Approximate duration of pregnancy can be
estimate by noting the fundal height in relation
to different level of the abdomen.
 Cont...
Braxton-hicks contraction are evident.
Palpation of fetal part by 20th weeks.
Active fetal movement
can be felt by placing
hand over the uterus.
External ballotment
is usually elicited.
c. Auscaltation -
FHS is most conclusive sign of pregnancy.
With an ordinary stethoscope, it can be
detected between 18 to 20 weeks.
The rates varies from 140-160 bpm but
gradually settles down to 120-140 bpm as
pregnancy advanced.
Two other sounds confused with FHS are :
Uterine souffle
Foetal souffle
• Vaginal examination -
a. Bluish discolouration of vulva, vagina
& cervix.
b. Increased softening of the cervix.
C. Ultrasonography -
At 18-20 weeks, routine sonography
diagnose about-
Foetal anatomy to detect any
malformation.
Placental localisation
Integrity of cervical canal
To determine gestational age by
measuring BPD, AC, FL,HC with more
accuracy in 2nd trimester.
D. Foetal skeletal shadow may be
visible at 16 week by radiological
evidence but this diagnosis is not
undertaken.
Third trimester (29 to 40 weeks)
A. Subjective symptoms -
 Some mechanical discomfort such as
palpitation, dyspnea, heart burn
produce from early third trimester.
• Lightening occur at about 38th week.
• Frequency of micturition reappears
after lightening.
• Foetal movements are more
pronounced.
B. Objective signs -
Cutaneous changes are more prominent with
increased pigmentation.
Uterine shape is changed from cylindrical to
spherical beyond 36 week.
Braxton hicks contraction are more evident.
Foetal movements are easily felt.
Palpatation of the foetal parts and their
identification become much easier.
FHS is heard distinctly in areas corresponding to
the presentation & position of the foetus.
Cont...
• FHS is not be audible in case of-
 Maternal obesity
 Polyhydramnios
 Occipito-poterior position and IUD
• Fundal height –
The distance between the umbilicus and the ensiform
cartilage is divided into 3 equal part.
C. Ultrasonography -
Gestational age estimation by BPD,
HC, AC and FL is less accurate .
Amniotic fluid assessment is done
to detect fetal well being.
If AFI is < 5=oligohydramnios or
If AFI is > 25=polyhydramnios.
To detect placental anatomy.
DIFFERENTIAL DIAGNOSIS
PSEUDOCYESIS
CYSTIC OVARIAN TUMOUR
FIBROID
ENCYSTED PERITONITIS
DISTENDED URINARY
BLADDER
SIGNS OF PREVIOUS
CHILDBIRTH
BREAST
ABDOMINAL WALL
UTERINE WALL
PERINEUM
INTROITUS
VAGINA
ESTIMATION OF GESTATIONAL
AGE & EXPECTED DATE OF
DELIVERY -

DATE OF FRUITFUL
COITUS
NAEGELE’S FORMULA
DATE OF QUICKENING
THAN
K
YOU.
MINOR ALIGNMENTS IN
PREGNANCY
NAUSEA AND VOMITTING
BACKACHE
CONSTIPATON
LEGCRAMPS
ACIDITY AND HEART BURN
VERICOSE VEIN
ANKLE OEDEMA