1. Diagnosis of pregnancy

2. Objectives At the end of the session will be able to:
Diagnose pregnancy from symptoms and signs.
Calculate the gestational age.
Define important terms related to pregnancy.

3. Diagnosis of pregnancy
Symptoms
Signs
Tests
False positives

6. Symptoms of pregnancy Cessation of menstruation Subjective symptoms
Morning sickness
Irritation of breasts
Nausea and vomiting
Fatigue
Increase in frequency of micturation

7. Signs of pregnancy Breast;
Fullness, areola pigmentation, Montgomery's tubercles( hypertrophied sebaceous glands), reliable sign in Primigravida.
Face;
Brown pigmentation, mask usually patchy (Cholasma)
Abdomen;
Linea nigra, brown or black pigmentation-stretching of collagen and elastin.
Striae gravidarum, stretch marks, red or purple during pregnancy, turns on to white after pregnancy. Situated in the lower abdomen, breasts, thighs, buttock.
Palpation, uterus palpable at 12 weeks of gestation

9. Vaginal examination Vaginal mucosa;
Jacquermin’s sign
Dark Bluish colouration Chadwick’s sign
Hegar’s sign of pregnancy
Bimanual palpation of soft uterine isthmus between the cervix and the body.
Cystic sensation of uterus by 8 weeks
Leukorrhea, increase in vaginal discharge

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11. Important Definitions
Gravid
Parous
Primigravida Nullipara or nulliparous
Multigravida Multiparous
Grand multiparaous

12. Calculation of the gestational age
Last menstrual period (LMP), regular, irregular, on the combined oral contraceptive pills, number of spontaneous cycles, bleeding in early pregnancy.
Expected date of delivery/ confinement (EDD, EDC),
Estimated by regularity of periods, no immediate past oral pills, no bleeding in early pregnancy.
Naegle’s rule, add one year
subtract 3 months
add 7 days

13. If the cycle is irregular, or was on the combined pills
How to estimate EDD; in the olden days and modern age????
Is the period of amenorrhae and the period of gestation the same????

14. Terms related to pregnancy
Term, It is a period of time . It is not the same as EDD
Preterm, before 37 completed weeks of gestation
Posterm, after 42 completed weeks of getation
Preterm and premature
Posterm and post maturity

15. Period of gestation (Trimesters)
Pregnancy is divided into three trimesters
First up to 14 weeks
Second up to 28 weeks of gestation
Third trimester up to 42 weeks of gestation.
Each trimester has its own problems/complications/events

16. First Trimester Confirm the pregnancy Symptoms and signs
Pregnancy tests
Antenatal Booking, type of care
Perinatal diagnosis.
Be alert, high hCG and empty uterus on USS , with or without vaginal bleeding, and with or without abdominal pain!!

17. Second trimester Perinatal diagnosis, USS Fetal quickening
Findings at ANC

18. Third trimester Findings at ANC Fetal assessment if indicated
Chronological hospital admissions if any

19. Important terms Braxton Hicks contractions;
Occurs from first trimester
painless
spontaneous
irregular
do not lead to labour
Lower uterine segment
The thin expanded lower portion of the uterus( the isthmus), forms in the last trimester of pregnancy, after 32 weeks of gestation. It provides the usual method of approach to deliver the baby during Caesarean section (CS).
Lightening
Usually occurs after 36 weeks, more in primigravida.
Mother notices that it is easier to breath.

20. More important terms Presenting part
The part of the fetus felt abdominally, vaginally
The four Leopoldt’s grip, with two hands
Fundal grip
Lateral grip
deep pelvic grip
Pawlik’s grip, Suprapubic palpation with one hand to identify the presenting part
To identify the station