The Diagnosis of Pregnancy Zhang Qingxue Departmentment of ob & gyn Sun yat-sen memorial hospital Sun yat-sen university

The Whole Period of Pregnancy Can Be Divided Into Three Stages: The first trimester (early pregnancy): 1-12w The second trimester (middle pregnancy): w The third trimester (late pregnancy): 28-40w

The Diagnosis of the First Trimester 1.History and symptoms A. Cessation of menstruation This is the first frequent symptom of pregnancy, 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.

1.The history and symptoms B. Nausea and vomiting Also called morning sickness because they occur upon arising. These symptoms appear one or two weeks after the period is missed and last until 10 th to 12 th week, its severity varies from mild nausea to persistent vomiting (e.g. Hyperemesis gravidarum).

1.The history and symptoms C. Urinary symptoms Increased frequency of urination is due to increased circulation associated with the effect of estrogen and progesterone on the bladder, combined with pressure by the gradually enlarged uterus on the bladder.

Internal genital organs

1.The history and symptoms D. Mastodynia It may be present in early pregnancy and ranges in severity from a tingling sensation to frank pain.

2. Signs Breast changes Breast enlargement and vascular engorgement. Nipple and areola become blacker. Enlargement of the accumulated sebaceous glands of the areolas (Montgomery’s tubercles) may be noted.

Fig.20-1 Breast changes. Montgomery’s glands are prominent, and nipples and areolae are deeply pigmented. Accessory nipple beneath left breast is also pigmented.

Changes of the reproductive organs Vagina: The vaginal wall become discoloration as the pelvic blood vessel becomes congested. Cervix: Cyanosis and a gradual softening due to congestion.

Changes of the reproductive organs Uterus: enlargement and softening. The isthmus of the uterus is also soft and can be compressed between the fingers palpating vagina and abdomen (Hegar’s sign). After the 12 th week, the fundus of the uterus is usually palpable above the symphysis pubis.

C. Supplementary examination Pregnancy test The laboratory test for pregnancy are based on the identification of human chorionic gonadotropin (hCG), which can be detected as early as 7-9 days after fertilization by high sensitive technique. The samples may be blood or urine.

Pregnancy test

Basal body temperature (BBT) A persistent elevation of BBT for longer than 18 days may be presumptive evidence of pregnancy.

Progesterone test Progesterone is given to a women with amenorrhea. If she is pregnant, no bleeding will follow, otherwise, bleeding should occur within 7-10 days of progesterone administration. This is reliable in the nonpregnant patient only if there is adequate estrogen stimulation of the endometrium.

cervical mucus The cervical mucus smear of pregnant women shows a progestational effect—that is ellipsoid instead of 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

Ultrasonography 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.

Ultrasonography Fetal heart beating can be detected by about 7th week and the fetus itself can be seen by about the 8th week. Doppler is also an ultrasound technique, which diagnoses the pregnancy by revealing the heart beating.

Picture of gestational sac

Picture of normal fetus a ． Pregnancy of 8w ； b ． Pregnancy of 18w BL-bladder ； UT-uterus ； GS-gestational sac

The diagnosis of the second and the third trimester pregnancy Symptoms Abdominal enlargement and fetal movement generally occurs after the 18 th to 20 th week of gestation.

Signs The uterus continues to enlarge Fetal movement (quickening) can usually be seen or heard after 18 th week of gestation

Height of the uterine top xiphoid

Signs 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 18 th to 20 th week of gestation unless the patient is too fat, the abdomen is tender or there is an excessive amount of amniotic fluid.

Fetal heart

(uterine souffle and umbilical souffle)

ballottement

Other 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 12 th week of pregnancy.

Different methods of pregnancy diagnosis

Fetal lie & fetal Presentation Fetal lie: the relationship between the long axis of the mother and the long axis of the fetus. (longitudinal lie and transverse lie) Fetal presentation: the portion of the fetus that descends into pelvis first.

fetal position Fetal position: the relationship of some guiding point of fetal presentation to a fined area of the maternal pelvis. (LOA, left occipital anterior)