Pregnanc Diagnosis

8/8/2019 Pregnanc Diagnosis

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The Whole Period ofThe Whole Period of

Pregnancy Can Be Divided IntoPregnancy Can Be Divided IntoThree Stages:Three Stages:

The first trimester (early pregnancy): 1-12wThe second trimester (middle pregnancy): 13-

27 w

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


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The Diagnosis of the First TrimesterThe Diagnosis of the First Trimester

1.History and symptoms

A. Cessation of menstruation

This is the first frequent symptom ofpregnancy, although a few women may

have slight bleeding after conception. But

amenorrhea is not only due to pregnancy

but also other reasons. Women of breast

feeding may be pregnant before the

recovery of menses.


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1.The history and symptoms1.The history and symptoms

B. Nausea and vomiting

Also called morning sickness because theyoccur upon arising. These symptoms

appear one or two weeks after the period

is missed and last until 10th to 12th week, its

severity varies from mild nausea to

persistent vomiting (e.g. Hyperemesis

gravidarum).


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C. Urinary symptoms

Increased frequency of urination is due toincreased circulation associated with theeffect of estrogen and progesterone on

the bladder, combined with pressure bythe gradually enlarged uterus on thebladder.


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Internal genital organsInternal genital organs


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D. Mastodynia

It may be present in early pregnancyand ranges in severity from a

tingling sensation to frank pain.


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2. Signs2. Signs

Breast changes

Breast enlargement and vascularengorgement. Nipple and areolabecome blacker. Enlargement of the

accumulated sebaceous glands of theareolas (Montgomerys tubercles)may be noted.


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Fig.20-1 Breast changes. Montgomerys glands are prominent,

and nipples and areolae are deeply pigmented. Accessory nippl

beneath left breast is also pigmented.


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Changes of the reproductive organsChanges of the reproductive organs

Vagina: The vaginal wall become

discoloration as the pelvic blood

vessel becomes congested.

(Chadwicks sign)

Cervix: Cyanosis and a gradualsoftening due to congestion.

(Goodells sign)


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Changes of the reproductive organsChanges of the reproductive organs

Uterus: enlargement and softening.

The isthmus of the uterus is also soft

and can be compressed between thefingers palpating vagina and

abdomen (Hegars sign). After the

12th

week, the fundus of the uterus isusually palpable above the

symphysis pubis.


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C. Supplementary examinationC. Supplementary examination

Pregnancy test

The laboratory test for pregnancy

are based on the identification ofhuman chorionic gonadotropin

(hCG), which can be detected as

early as 7-9 days after fertilizationby high sensitive technique. The

samples may be blood or urine.


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Pregnancy testPregnancy test


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Basal body temperature (BBT)Basal body temperature (BBT)

A persistent elevation of BBT forlonger than 18 days may be

presumptive evidence of

pregnancy.


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Progesterone testProgesterone test

Progesterone is given to a womenwith amenorrhea. If she is pregnant,

no bleeding will follow, otherwise,bleeding should occur within 7-10days of progesterone administration.This is reliable in the nonpregnant

patient only if there is adequateestrogen stimulation of theendometrium.


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cervical mucuscervical mucus

The cervical mucus smear of

pregnant women shows aprogestational effectthat is

ellipsoid instead of fern

crystallization.


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cervical mucous (1) type ( ) typical fern crystallization (2) type ( )

fern crystallization (3) type ( ) atypical fern crystallization(4) type ( ) ellipsoid


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UltrasonographyUltrasonography

There are trans-vaginal and

abdominal Ultrasonagraphys.

A gestational sac can usually be

identified at 5-6 weeks after the

beginning of the last period.


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UltrasonographyUltrasonography

Fetal heart beating can be detected

by about 7th week and the fetus

itself can be seen by about the 8thweek.

Doppler is also an ultrasound

technique, which diagnoses thepregnancy by revealing the heart

beating.


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Picture of gestational sac


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Picture of normal fetus

a Pregnancy of 8w b Pregnancy of 18w

BL-bladder UT-uterus GS-gestational sac


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The diagnosis of the second and theThe diagnosis of the second and the

third trimester pregnancythird trimester pregnancy

SymptomsAbdominal enlargement and

fetal movement generally occurs

after the 18th

to 20th

week ofgestation.


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SignsSigns

The uterus continues to enlarge

Fetal movement (quickening)

can usually be seen or heard

after 18th week of gestation


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Height of the uterine topHeight of the uterine top

xiphoid


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SignsSigns

Fetal heart sound can be heard at

rate varies from 120 to 160 beats per

minute.The fetal body can usually be

palpated by the 18th to 20th week of

gestation unless the patient is too fat,the abdomen is tender or there is an

excessive amount of amniotic fluid.


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Fetal heartFetal heart


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ballottement


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Other ExaminationsOther Examinations

Ultrasonography.

X-ray. It is rarely used recently

because the harmfulness to the fetus.Fetal electrocardiogram. A fetal

electrocardiogram can first be

recorded at about the 12th

week ofpregnancy.


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Fetal lie & fetal PresentationFetal lie & fetal Presentation

Fetal lie: the relationship between

the long axis of the mother and thelong axis of the fetus. (longitudinal

lie and transverse lie)

Fetal presentation: the portion of thefetus that descends into pelvis first.


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fetal positionfetal position

Fetal position: the relationship of

some guiding point of fetal

presentation to a fined area of thematernal pelvis. (LOA, left occipital

anterior)


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Pregnanc Diagnosis

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