2 diagnosis of pregnancy

Diagnosis of PregnancyDiagnosis of Pregnancy

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Review

Pregnancy (gestation) Pregnancy (gestation) Fetal Growth And Development Fetal Growth And Development Fetal appendage Maternal physiology during pregancyMaternal physiology during pregancy

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Multiple choice questions Multiple choice questions Hormone X is secreted in the follicular phase and are Hormone X is secreted in the follicular phase and are responsible for suppressing FSH in the late follicular phase prior responsible for suppressing FSH in the late follicular phase prior to ovulation. What is hormones X ?to ovulation. What is hormones X ?

(A) LH(A) LH

(B) FSH(B) FSH

(C) (C) progesteroneprogesterone

(D) estrogen (D) estrogen

(E) testosterone(E) testosterone

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• Female, 25 years old, married, normal Female, 25 years old, married, normal menstrual cycle, not contraception, menstrual cycle, not contraception,

• the first day of the last menstrual the first day of the last menstrual period (LMP) is 2011/01/20period (LMP) is 2011/01/20

• Now she come to ……Now she come to ……

How consider about ?How consider about ?

If you are a doctor in If you are a doctor in clinic…………

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cessation menstruation

First trimester

ectopic

DUB PCOSPCOS

Impuberalpost-menop

ause

GTD lactation

General

disease

neoplasms

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Diagnosis of of pregnancy

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Diagnosis of of pregnancy almost the most important in women life to othersalmost the most important in women life to others Medical doctors have the knowledge about pregnMedical doctors have the knowledge about pregn

ancy important ,ancy important ,no matter how the practice characteristics and professionno matter how the practice characteristics and profession

alal

Whether she was pregnant ?Whether she was pregnant ? Incorret diagnosis and inappropriate treatmenIncorret diagnosis and inappropriate treatmen

t →t →judicial interventionjudicial intervention

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The Whole Period of Pregnancy Divided The Whole Period of Pregnancy Divided Into Three Stages:Into Three Stages:The whole process of pregnancy from the first day of the last menstrual period (LMP) with an average 280 days, 40

weeks

The first trimester (early pregnancy): 1-12wThe first trimester (early pregnancy): 1-12w

The second trimester (middle pregnancy): 13-27 wThe second trimester (middle pregnancy): 13-27 w

The third trimester (late pregnancy): 28-40wThe third trimester (late pregnancy): 28-40w

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Diagnosis of Early PregnancyDiagnosis of Early Pregnancy History and symptoms History and symptoms on the basis of a historyon the basis of a history ，， enlarging uterus and a positive preenlarging uterus and a positive pre

gnancy test. gnancy test.

1.1. AmenorrheaAmenorrhea The first and the most important symptom The first and the most important symptom with regular menstrual cycles

emotional tension, chronic disease , certain medications genemotional tension, chronic disease , certain medications genitourinary tumorsitourinary tumors → delayed menses→ delayed menses

Differential Diagnosis ： lactation, oral contraception,lactation, oral contraception, endocrine disorder

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Diagnosis of Early PregnancyDiagnosis of Early Pregnancy

2. Morning sickness2. Morning sickness Nausea and vomitingNausea and vomitingoccurs in about 50% of pregnancies.occurs in about 50% of pregnancies. (the 6 (the 6thth week week↑↑ →→

the 12the 12thth week week↓↓ ) ) Causes: HCG, delayed gastric emptying(PCauses: HCG, delayed gastric emptying(P↑↑ ) )

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3.3. Urinary symptomsUrinary symptoms Bladder irritability, frequency and nocturiaBladder irritability, frequency and nocturia Causes: Causes: increased circulation in pelvis (E and Pincreased circulation in pelvis (E and P↑↑) ) enlargement of uterus.enlargement of uterus. Differential Diagnosis: urinary infection urinary infection

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Diagnosis of Early PregnancyDiagnosis of Early Pregnancy4.4. Mastodynia Mastodynia breast tendeness from tingling to frank breast tendeness from tingling to frank

painpain Causes: Causes: the development of mammary ducts (Ethe development of mammary ducts (E↑↑) )

and alveolar system (Pand alveolar system (P↑↑))

circulationcirculation↑→↑→ engorgement of the breasts engorgement of the breasts

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Diagnosis of Early PregnancyDiagnosis of Early Pregnancy SignsSigns1 The changes of genital organs1 The changes of genital organs Vagina: bluish or purple discoloration (congested Vagina: bluish or purple discoloration (congested

pelvic vasculature). Increased vaginal discharge (E pelvic vasculature). Increased vaginal discharge (E and Pand P↑↑))

Cevix: softening and bluish discoloration. Cevix: softening and bluish discoloration. Enlargement of uterus (noticed at the 12Enlargement of uterus (noticed at the 12thth week ) week )

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Diagnosis of Early PregnancyDiagnosis of Early Pregnancy Hegar’s signHegar’s sign: Widening of the softened area of the isth: Widening of the softened area of the isth

mus, in compressibility on bimanual examination.mus, in compressibility on bimanual examination.

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Diagnosis of Early PregnancyDiagnosis of Early Pregnancy2.2. Breast changesBreast changes Enlargement Enlargement the development of mammary ducts and althe development of mammary ducts and al

veolar system veolar system engorgement of breastsengorgement of breasts sebaceous glands( Montgomery's tuberclesebaceous glands( Montgomery's tubercle

s)s) Linea Nigra :darkening of NipplesLinea Nigra :darkening of Nipples..

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Assistant ExaminationAssistant Examination1 Pregnancy test1 Pregnancy test the simplest and most common method the simplest and most common method

Urine HCG test : + or –Urine HCG test : + or – Urine HCC test + about 95% of the possibility of pregnancyUrine HCC test + about 95% of the possibility of pregnancy

blood blood ββ-HCG: -HCG: a sensitive and specific test , early pregnancy tests identa sensitive and specific test , early pregnancy tests identification of human chorionic gonadotropin (ification of human chorionic gonadotropin (hCGhCG)as early as 7-9 days after fer)as early as 7-9 days after fertilization tilization

blood blood ββ-HCG + about 99% of the possibility of pregnancy-HCG + about 99% of the possibility of pregnancy

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Pregnancy testPregnancy test

Urine HCG testUrine HCG test

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2.2. UltrasonographyUltrasonography Enlargement of uterusEnlargement of uterus Gestational Gestational sac Embryo or fetal pulse Embryo or fetal pulse at 5-6 week

Crown to rump length(CRL) Crown to rump length(CRL) meme

asured at 5 -12 weeks the most accurate gestational agasured at 5 -12 weeks the most accurate gestational age.e.

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Genetic screen/prenatal screenGenetic screen/prenatal screen

nuchal translucency（ NT）Early pregnancy signs commonly used in genetic screening

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First Trimester Down syndrome screening

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Teratogenic fetal organs of the sensitive period map Teratogenic fetal organs of the sensitive period map

For structural malformations,embryo is the most important, Continued development of functional is very important at fetus

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3. Basal body temperature 3. Basal body temperature ((BBT)BBT)

A persistent elevation of BBT for longer than 18 daysA persistent elevation of BBT for longer than 18 days

may be presumptive evidence of pregnancy.may be presumptive evidence of pregnancy.

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4. Progesterone test4. Progesterone testProgesterone given to amenorrhea.

pregnant, no bleeding follow nonpregnant bleeding should oc

cur within 7-10 days of progesterone

adequate estrogen stimulation of the endometrium.

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5. Cervical mucus5. Cervical mucus The cervical mucus smear The cervical mucus smear a progestational effect— a progestational effect— ellipsoid ellipsoid →→ fern crystallization. fern crystallization.

cervical mucous 　　　　　　(1) type (Ⅰ ＋＋＋ ) ： typical fern crystallization (2) type (Ⅱ ＋＋ ) ： fern crystallization (3) type (Ⅲ ＋ ) ： atypical fern crystallization 　 (4) type (Ⅳ － ) ： ellipsoid

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Diagnosis of mid or late pregnancyDiagnosis of mid or late pregnancy History History 、、 Symptoms and sigSymptoms and sig

nn Early pregnancy course Early pregnancy course Abdomen gradually increasingAbdomen gradually increasing

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Diagnosis of mid or late pregnancyDiagnosis of mid or late pregnancy Symptoms and signSymptoms and sign1.1. Enlargement of uterusEnlargement of uterus 1212thth week: 2 finger above the symphysis week: 2 finger above the symphysis 1616thth week: midway between the symphysis and the umbilicus. week: midway between the symphysis and the umbilicus. 2020thth week: at the umbilicus week: at the umbilicus 2424th th week: 2 finger above the umbilicus.week: 2 finger above the umbilicus. 2828th th week:3 finger above the umbilicus.week:3 finger above the umbilicus. 3232th th week: midway between the umbilicus and week: midway between the umbilicus and xiphoid bone 3636th th week: 2 finger below the week: 2 finger below the xiphoid bone 4040th th week: midway between the umbilicus and week: midway between the umbilicus and xiphoid bone

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Diagnosis of mid or late pregnancyDiagnosis of mid or late pregnancy

2. Fetal movement (FM)2. Fetal movement (FM) The first perception: in the 18The first perception: in the 18thth – 20 – 20thth weeks weeks multipara /primipara

Diagnosis of pregnancy, the safety of fetusDiagnosis of pregnancy, the safety of fetus

Count: 3 times per dayCount: 3 times per day

1 hour per time. sum1 hour per time. sum××4= FM/12 hours4= FM/12 hours

Normal: Normal: ≥≥ 4/ hour , 4/ hour ,≥≥ 30/12 hours 30/12 hours

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3. Fetal heart tones3. Fetal heart tones Heared: the 18th – 20th weeks by fetoscope /the 10th weeks by D

oppler ultrasound

Normal rate: 120-160（ bpm ）） beats per minute Differentiation: umbilical souffle etcDifferentiation: umbilical souffle etc

4. Fetal body4. Fetal body Palpated: outlines from maternal abdominal wall(the 20Palpated: outlines from maternal abdominal wall(the 20thth week). week).

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Assistant ExaminationAssistant Examination Ultrasonography Ultrasonography

Measure Measure fetal growth parameterfetal growth parameter amniotic fluid volume placenta umbilicus cord

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Exclusion fetal malformations Exclusion fetal malformations Normal Normal

spinespine

NTDNTD

Spinal cleftanencephalus

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Size ofSize of fetus:fetus:fetal biparietal diameter/ Fetal femur length/abdominal fetal biparietal diameter/ Fetal femur length/abdominal circumference circumference

Fetal well-being :Fetal well-being :measure biophysical characteristics. measure biophysical characteristics. Placenta maturityPlacenta maturity Amniotic fluid volume Umbilical Cord Blood number of fetusnumber of fetus

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Fetal electrocardiography Fetal electrocardiography （（ FECGFECG ））

1212thth week week

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Fetal AttitudeFetal Attitude

The posture of fetus in the The posture of fetus in the uterus Fetal lieFetal lie the relationship of the long axis of the fetus to the long axis of the relationship of the long axis of the fetus to the long axis of

the motherthe mother Longitudinal lieLongitudinal lie long axis of fetus parallel with motherlong axis of fetus parallel with mother Transverse lieTransverse lie long axis of the fetus vertical motherlong axis of the fetus vertical mother

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Fetal AttitudeFetal Attitude Fetal presentation:Fetal presentation: first part of the fetus into pelvicfirst part of the fetus into pelvic

head presentationhead presentation Occiput presentation (95%)Occiput presentation (95%) anterior fontanelle presentationanterior fontanelle presentation brow presentation brow presentation face presentationface presentation

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Fetal presentationFetal presentation Breech presentationBreech presentation Complete breech presentationComplete breech presentation Frank breech presentationFrank breech presentation Incomplete breech presentation: footling presentationIncomplete breech presentation: footling presentation

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Fetal AttitudeFetal Attitude Fetal positionFetal position relationship of relationship of the point of directionthe point of direction to one o to one o

f the 4 quadrants of the pelvis f the 4 quadrants of the pelvis Occiput presentation: the occiput, O. LOA,LOcciput presentation: the occiput, O. LOA,L

OT,LOPOT,LOP Face presentation: Face presentation: mandibular,M. LMA,LM,M. LMA,LM

T,LMPT,LMP Breech presentation:sacrum,S.Breech presentation:sacrum,S. LSA,LST,LSPLSA,LST,LSP

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symptoms and signs of pregnancy diagnosissymptoms and signs of pregnancy diagnosis

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Summary

Whole pregnancy process by stages Diagnosis of Early PregnancyDiagnosis of Early Pregnancy Diagnosis of mid or late pregnancyDiagnosis of mid or late pregnancy Fetal AttitudeFetal Attitude

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The Whole Period of Pregnancy Divided The Whole Period of Pregnancy Divided Into Three Stages:Into Three Stages:from the first day of the last menstrual period (LMP) with an average 280 days, 40 weeks

The first trimester (early pregnancy): 1-12wThe first trimester (early pregnancy): 1-12w

The second trimester (middle pregnancy): 13-27 wThe second trimester (middle pregnancy): 13-27 w

The third trimester (late pregnancy): 28-40wThe third trimester (late pregnancy): 28-40w

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Diagnosis of Early PregnancyDiagnosis of Early Pregnancy History and symptoms:History and symptoms: Amenorrhea

Morning sickness

Urinary symptoms

Mastodynia SignsSigns The changes of genital organs Breast changes

Assistant ExaminationAssistant Examination

Pregnancy test Pregnancy test

UltrasonographyUltrasonography

Basal body temperature Basal body temperature

Progesterone test Progesterone test

Cervical mucus Cervical mucus

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Diagnosis of mid or late pregnancyDiagnosis of mid or late pregnancy History and symptoms: History and symptoms: Early pregnancy course Abdomen gradually increasing

Symptoms and SignsSymptoms and Signs Enlargement of uterus Fetal movement Fetal heart tones Fetal body

Assistant ExaminationAssistant Examination

Ultrasonography

Fetal electrocardiography

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Fetal lie Fetal lie Fetal presentationFetal presentation Fetal position Fetal position

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• Female, 25 years old, married, normal Female, 25 years old, married, normal menstrual cycle, not contraception, menstrual cycle, not contraception,

• the first day of the last menstrual period the first day of the last menstrual period (LMP) is 2011/01/20(LMP) is 2011/01/20

• Now she come to ……Now she come to ……

How consider about ?How consider about ? How do you do first?How do you do first?

If you are a doctor in If you are a doctor in clinic…………

Thanks for Your Thanks for Your AttentionAttention

第七版《妇产科学》配套课件第七版《妇产科学》配套课件主编：乐杰谢幸林仲秋苟文丽狄文主编：乐杰谢幸林仲秋苟文丽狄文

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THANKS FOR YOUR THANKS FOR YOUR ATTENTION!ATTENTION!

2 diagnosis of pregnancy

Health & Medicine

Transcript of 2 diagnosis of pregnancy