GARBINI LAKSHANADAGNOSIS OF PREGNANCY

PERSENTED BY S.SUJI

III PROFESSION

INTRODUCTION

In Ayurvedic classical text garbini lakshanas are described under two headings they are

1.Sadyo grhita garba laksana 2.Vyakta garba laksana

Sadyo Grhita Garba Laksana

Tatra sadyogrhita graba lingani – srama glani pipasa saktisadanam sukrasonita avabhandha spuranancha yoni sus.sa.3/11

Nistivika gourava angasada tandra praharsa hrdaya vyaktha tripti bijagrahanam cha yoni grabasya sadyo anugatasya lingam cha.sa.2/23

Vyakta garba laksana

Artava adarsana (amenorrhoea), Anannabhilasa (loss of desire for

food), Cardi (vomiting without any reason), Arocaka (anorexia), Amlakamata (desire for sour tasted

food) Sraddha pranayana ucchavacesu

bhavesu (liking of all type of food- both wholesome and unwholesome),

Gurugatrata(heaviness in body),

Cont…..

Caksu glani (weakness of eyes), Stanyo stanyam (appearance of breast milk) ostayo stanamandala atyarta karsnata

(excessive blackish discolouration of lips and areola)

Padayo svayathu(oedema in pada) Esat lomaraji udgama (linea nigra

appearance) Yoni caatalata (vaginal dilatation)

Late signs of pregnancy

Appearance of Montgomery tubercle in the areola

Abdominal stria

Linea nigra

Diagnosis of pregnancy

There are three stage for diagnosing pregnancy

First trimester (first 12 weeks) Second trimester (13-28 weeks) Last trimester (29-40 weeks)

FIRST TRIMESTER (FIRST 12 WEEKS)Cessation

of menstruati

on Morning sickness

frequency of

urination

Appetite changes

Breast symptoms

FIRST TRIMESTER (FIRST 12 WEEKS)

Morning sickness

frequency of urination

signs

Increased size and vascularity. Increased pigmentation of the nipple. Appearance of areola. Appearance of dilated sebaceous glands in areola. Expression of colostrum.

Size : enlarged.consistency :

soft.Shape : globular.

Hegar sign Palmer sign

Leucorrhea Increased vaginal discharge. Chadwick‘s sign: Bluish discoloration of the vagina and cervix. Goodell‘s sign: Cyanosis and softening of the cervix at 4 weeks

Hegar’s sign

Second trimester (13-28 weeks)

AmenorrheaMorning sickness

and urinary symptoms gradually decrease .

Quickening

• 18-20 weeks in primigravida

• 16-18 week s in multipara.

Abdominal enlargement.

signs1. Breast changes become more evident.2. The uterus is abdominally felt.3. Braxton Hicks contractions; intermittent

painless contractions detected by abdominal examination.

4. Internal ballottement : elicited at 16 week , it can be demonstrated by pushing the fetus through the anterior fornix using 2 fingers.

5. External ballottement : elicited at 20 week through abdominal examination.

6. Palpation of the fetal parts and palpation of fetal movements by the obstetrician at 20 weeks.

7. Auscultation of the F.H.S. at 20- 24 weeks by pinard‘s fetal stethoscope.

Breast signs

Increased pigmentation of the nipple and lry areo

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THE THIRD TRIMESTER (29-40 WEEKS)

Sure Signs of Pregnancy

Palpation of foetal parts & its

movements

Auscultation of foetal heart

sounds

The occasional auscultation of the umbilical (funic) souffle

USG detection of foetal parts,

movements and heart movements

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Investigations

Pregnancy tests Urine pregnancy tests Serum pregnancy tests ELISA test Ultrasonography

Pregnancy tests

HCG in the urine or Detection ofserum .

Urine pregnancy tests

Classically it becomes +Ve 7- 10 day after 1st missed period

Commercial testing kits are available that are sensitive to 25 iu/L in urine.

By the time the mother has missed

her first menstrual period, her hCG levels are around 100 iu/L.

Serum pregnancy tests

Classically it becomes +Ve 5- 7 days before 1 st missed period

A quantitative serum HCG assay level of > 5 iu/L will usually denote a pregnancy.

With a normal intrauterine pregnancy, the hCG level doubles approximately every 36-48 hours.

ELISA pregnancy slide test:

can detect pregnancy starting from 48 hours after the missed period.

Ultrasonography

Vaginal: Gestational sac : 4 weeks. One fetal pole : 5 weeks. Two fetal poles : 6 weeks. Fetal heart activity : 7 weeks.Abdominal: The previous findings can be

detected one week later.

DIFFERENTIAL DIAGNOSIS OF PREGNANCY

The clinical diagnosis of pregnancy at times becomes easy but there are occasion where the diagnosis poses a problem.

Pseudocyesis Cystic ovarian tumor Fibroid Encysted peritonitis Distended urinary bladder

DIFFERENTIAL DIAGNOSIS Pseudocyesis Cystic ovarian tumor

Fibroid Encysted peritonitis

Common symptoms

•Cessation of menstruation•Enlargement of abdomen•Intestinal movement •Secretion from breast

•Swelling of abdomen (month wise growth)

•Slow growing of tumor

•Amennorrhea of longer duration

Differential Diagnosis

•Pregnancy test negative•Ultrasound test diagnosis shows negative

•Amenorrhea is absent•Feels cyst•Pregnancy test negative•USG shows absence of foetus

•Amenorrhea is absent•Feels hard mass•Pregnancy test•USG shows absence of foetus

•Swelling is ill defined•Pregnancy test•USG shows absence of foetus

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