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
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
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