Diagnosis of Pregnancy Liu Wei Department of Ob & Gy Ren Ji hospital
Diagnosis of Early Pregnancy • History and symptoms • Amenorrhea • The first and the most important symptom • Note 1: emotional tension, chronic disease and certain medications → delayed menses • Note 2: lactation, IUD and dysfunction of endocrine → pregnancy
Diagnosis of Early Pregnancy • Morning sickness • Fatigue, swirling, nausea and vomiting (the 6th week↑→ the 12th week↓ ). • Hyperemesis gravidarum (妊娠剧吐): protracted vomiting necessitating hospitalization. • Causes: HCG, delayed gastric emptying(P↑ )
Diagnosis of Early Pregnancy • Urinary symptoms • Bladder irritability, frequency and nocturia • Causes: increased circulation in pelvis (E and P↑), enlargement of the uterus. • Note: urinary infection must be ruled out
Diagnosis of Early Pregnancy • Mastodynia (乳房胀痛) • the development of mammary ducts (E↑) and alveolar system (P↑) • circulation↑→ engorgement of the breasts • Constipation (便秘) smooth muscle relaxant (P↑) • Weight gain
Diagnosis of Early Pregnancy • Signs • The changes of genital organs • Vagina: bluish or purple discoloration (congested pelvic vasculature). Increased vaginal discharge (E and P↑) • Cevix: softening and bluish discoloration. The cervical mucus→ a granular pattern • Uterocervical junction Hegar’s sign: a widened zone of softness coupled with compressibility, resulting in a doughnut-shaped, slightly spongy configuration.
Diagnosis of Early Pregnancy • Abdominal enlargement Enlargement of uterus (noticed at the 12th week) • Breast changes • Enlargement and vascular engorgement (6th –8th week) • Montgomery’s tubercles (蒙氏结节): 6th –8th week, E and P↑ • Colostrum secretion (16th week) or secondary breasts
Diagnosis of Early Pregnancy • Laboratory tests • Pregnancy test • Urine HCG test (one step): + or – • β-HCG: >25mIU/L • Ultrasonography • Enlargement of uterus • Gestational sac • Embryo or fetal pulse
Diagnosis of Early Pregnancy • Other tests • Progesterone test • Cervical mucus examination • Basal body temperature (BBT)
Diagnosis of mid or late pregnancy • Symptoms and signs • EDC: +9 or –3 (month), +7 (day) • Enlargement of uterus • 12th week: 2 finger above the symphysis • 16th week: midway between the symphysis and the umbilicus. • 20th – 22nd week: at the umbilicus • …….
Diagnosis of mid or late pregnancy • Fetal movement (FM) • The first perception: in the 18th – 20th weeks • Diagnosis of pregnancy, duration of pregnancy, the safety of fetus • Count: 3 times per day, 1 hour per time. sum×4= FM/12 hours. Normal:≥ 30/12 hours
Diagnosis of mid or late pregnancy • Fetal heart tones • Heared: the 18th – 20th weeks • Normal rate: 120-160bpm • Differentiation: umbilical souffle (脐带杂音) • Fetal body Palpated: outlines of the fetus (the 20th week).
Diagnosis of mid or late pregnancy • Laboratory tests • Ultrasonography • The number of fetus • Fetal lie • Fetal presentation • Fetal position • Fetal dead or not • Placenta and cord (velocity of flow) • Size of fetus
Diagnosis of mid or late pregnancy • Fetal electrocardiography, FECG 12th week
Fetal Attitude • Fetal lie Refers to the relationship of the long axis of the fetus to the long axis of the mother • Longitudinal lie The long axis of the fetus is parallel with that of the mother • Transverse lie The long axis of the fetus crosses that of the mother vertically
Fetal Attitude • Fetal presentation • head presentation Occiput presentation (95%), brow presentation and face presentation. • Breech presentation • Complete breech presentation • Frank breech presentation • Incomplete breech presentation: footling presentation
Fetal Attitude • Fetal position Refers to the relationship of the point of direction of the presenting part to one of the 4 quadrants of the pelvis or to the transverse diameter of the maternal pelvis. • Occiput presentation: the occiput, O. LOA,LOT,LOP • Face presentation: the chin, M. LMA,LMT,LMP • Breech presentation: the sacrum, S.LSA,LST,LSP