Download diagnosis of pregnancy

DIAGNOSIS OF
PREGNANCY
DR.SHARON
PREGNANCY
It can be defined as the condition of having a
developing embryo or fetus in the body after
successful conception.
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DURATION OF PREGNANCY:
lCalculated in terms of 10 lunar months/9
calendar months and 7 days.
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MENSTRUAL AGE
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Or gestational age
From the first day of the last
menstrual period...
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294 days or 42 weeks
TRIMESTERS
1.FIRST TRIMESTER:1st 12
weeks
2.SECOND TRIMESTER:13 to
28 weeks
3.THIRD TRIMESTER:29 to 42
weeks
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Diagnosis in 1 trimester
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SYMPTOMS:
1.CESSATION OF MENSTRUATION:(missed
period):due to increased estrogen and
progesterone production by the corpus
luteum.
Slight bleeding at the expected time of
menstruation ,rarely occours in the first three
months(hartman's sign/placental sign)scanty
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2.MORNING SICKNESS:(70% cases)
Usually appears soon following the missed
period.
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Nausea,vomiting especially in the morning
on rising from the bed
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Usually disappears after the third month.
3.FREQUENCY OF MICTURITION:
Irritation of bladder due to congestion of bladder
mucosa by the pregnant uterus.
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Resting of bulky uterus on the bladder
Change in maternal osmoregulation(increased
thirst and polyuria)
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4.BREAST SYMPTOMS:
Enlargement,heaviness,discomfort
and pricking
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sensation-6 to 8 week in primigravidae.
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5.APPETITE CHANGES:
Craving for certain types of food and refusal of
other types.
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6.FATIGUE:
Frequent symptom,tendency to sleep.
OBJECTIVE SIGNS
BREAST CHANGES
lUTERINE CHANGES
lPELVIC CHANGES
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BREAST CHANGES:
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Changes evident between 6 8 week
Increased size and vasularity-dilated
visible veins.
Increased pigmentation of the areola
and nipple,appearance of secondary
areola
Appearance of montgomery tubercles
in the areola
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Expression of colustrum(by 12 week)
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PELVIC CHANGES:
-uterus thremains a pelvic organ
until 12 week,it maybe just felt
as a supra pubic bulge
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*JACQUEMIER'S / CHADWICK'S SIGN
*OSIANDER'S SIGN
*GOODELL'S SIGN
LADIN'S SIGN:at 6 weeks ,uterus softens in
midline along uterocervical junction..
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Mc DONALD'S SIGN:uterus becomes flexible at
uterocervical junction at 7-8 weeks
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VON FERNWALD SIGN:softening of fundus at 45 weeks.
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2.UTERINE
CHANGES:
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In 1 trimester itthgrows to a size
of hens egg at
th 6 week, cricket
ball size at 8 week
and size of
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fetal head by 12 week.
Pyriform shape of uterus
becomes globular by 12 weeks
*PISKACEK'S SIGN
*HEGAR SIGN
*PALMAR SIGN
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IMMUNOLOGICAL TESTS
HCG
This hormone is only released by
trophoblastic tissue produced by a
growing fetus and its associated
placents.
HCG is present in the maternal
circulation as either an intact
dimer,alpha or beta subunit,and
degraded form,or beta core fragment
Detection in maternal and urine is
evident only 8-10 days after conception
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HCG is detectable in the serum
of 5% of patients 8days after
conception and in more than
98%of patients by day 11.
Diagnostic levels in urine seen
only about 23-24 days after
conception.
Leves peak at 10-12 weeks and
then plateau before falling.
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Blood tests for HCG
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A.immunoassay with radioisotopes:
1.radio-immunoassay(0.002IU/mL)
2.immunoradiometric assay(0.05mIU/mL)
B.Immunoassays without radioisotopes:
1.agglunitation inhibition test(0.5-1IU/mL)
2.direct agglutination test0.2IU/mL)
3.ELISA(30-50mIU/mL)
4.fluoroimmunoassay(1mIU/mL)
ULTRASOUND
Intra decidual sac is identified as early
as 29-35 days of gestation
Gestational sac and yolk sac -5
menstrual weeks
Fetal pole and cardiac activity-6weeks
Embroyonic movements-7weeks
Doppler effectth of US can pick heart rate
reliably by 10 week.
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DIAGNOSIS IN 2
TRIMESTER
1.amenorrhea
2.morning sickness:urinary
symptoms gradually decrease
3.”Quickening”:
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a.18-20 weeks in primigravida
b.16-18 weeks in multipara
4.abdominal enlargment
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ABDOMINAL
EXAMINATION
Inspection
Linea nigra
extending from
symphysis
pubis to
ensiform
cartilage.
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striae visible in
the lower
abdomen
more towards
the flanks.
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PALPATION
Fundal heightincrease with
progressive
enlargment of
the uterus.
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Auscultation
FHS as early as 20-24 weeks
Funic/fetal souffle-due to rush of
blood through umbilical artery,heard at
the sids of the uterus,synchronous with
the fetal pulse.
Uterine souffle-soft blowing and
systolic murmur,heard on the
sides,synchronous with maternal pulse
due to increased blood flow through the
dilated uterine vessels.
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Investigations...
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Sonography:
routine sonography at 18-20 weeks
permits a detailed survy of fetal
anatomy,placental localization and the
integrity of the cervical canal.
Fetal organ anatomy:
-to detect any malformation
Fetal viabality
Radiologic
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-16 week fetal skeletal shadow
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DIAGNOSIS IN 3
TRIMESTER
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SYMPTOMS:
-amenorrhea persists
-enlargment ofth the abdomen
-lightening:38 week, sense of relief of
pressure symptoms due to engagement
of the presenting part.
-frequency of micturition reappears
-fetal movements are more
pronounced.
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SIGNS:
-cutaneous changes are more
prominent with increased pigmentation
and striae.
-uterine shape-from thcylindrical to
spherical beyond 36 week
FUNDAL HEIGHT:comes
down to 32
th
week level at 40 week because of
engagement of the presenting part.
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Symphysis fundal height:
-distance between the upper border of
symphysis pubis upto the upper border
of fundus.
-after 24 weeks SFH corresponds to
the number of weeks upto 36weeks.
-fetal movements easily felt
palpation of fetal parts becomes easier
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-FHS heard distinctly
SONOGRAPHY:
-fetal growth assessment can be
made more accurately
-amniotic fluid volume
assessment.
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THANKYOU.