Diagnosis of pregnancy

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.

Diagnosis of pregnancy Symptoms Signs Tests False positives

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

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

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

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

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????

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

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

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!!

Second trimester Perinatal diagnosis, USS Fetal quickening Findings at ANC

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

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.

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