Diagnosis of Pregnancy Departmentment of ob & gyn Renmin Hospital of Wuhan University Zhuoni Xiao
Woman’s reproductive period Menarche Menopause 13-45 years
DurationofPregnancy 10 lunar months ; 9 calendar months and 7 days ; 280 days ; 40 weeks Menstrual or gestational age
Fertilization or Ovulatory age 280 days -14 days=266 days
First trimester: first 12 weeks • Second trimester: 13-28 weeks • Last trimester: 29-40 weeks
First trimester • Subjective Symptoms • Objective Signs • Immunological Tests • Ultra Sonograph Pregnancy Diagnosis
Subjective Symptoms • Amenorrhoea Warning :cyclic bleeding may last up to 12 weeks; scanty and short time; pathological bleeding ,such as miscarriage
Morning Sickness Usually appears soon following the missed period; Rarely lasts beyond 3 months
Frequence of micturition troublesome symptom during 8-12 weeks enlarged uterus congestion of bladder change in maternal osmoregulation
Breast discomfort Fullness Pricking sensation
Fatigue Occur early in pregnancy
Objective Signs • Breast changes valuable only in primigravidae breast changes are evident between 6-8 weeks (vascular engorgement & nipple and areola pigment) Montgomery’s tubercle colostrum expressed as early as 12th weeks
Per Abdomen Uterus remains a pelvis organ until 12 weeks
Pelvic Changes Chadwick’ sign Vaginal sign Cervical sign Uterine sign
Chadwick’ sign is a bluish discoloration of the cervix,vagina, and labia caused by the hormone estrogen which results in . It can be observed as early as 6-8 weeks after conception, and its presence is an early sign of pregnancy.
Vaginal sign (Osiander’s sign) Bluish discolouration of anterior vaginal wall Vaginal wall soften Mucoid discharge Increased pulsation
Cervical sign (Goodell’ sign) Become soft as early as 6th week Non pregnant uterus Pregnant uterus
Uterine sign Size, shape and consistency 6th week 8th week 12th week Asymmetric→Symmetric The pregnant uterus feels softand elastic
Hegar’s sign demonstrated between 6-10 weeks Upper part of the body of the uterus is enlarged by growing fetus; Lower part of the body of the uterus is empty and extremely soft; The cervix is comparatively firm
The abdominal fingers behind the uterus The abdominal and vaginal fingers seem oppose below the body of uterus Two fingers in the anterior fornix
Palmer’s sign Regular and rhythmic uterine contraction can be elicited doring biomanual examination as early as 4-8 weeks
Principle of pregnancy test detection of the antigen of HCG present in the maternal urine or serum • Selectionn of time 8-10 days after conception • Collection of urine the first voided urine in the morning in a clean container
Ultra Sonograph Gestation sac (GS) can be identified as early as 29-35 days of gestation
First Trimester Review The Whole Period of Pregnancy Can Be Divided Into Three Stages The first trimester (early pregnancy): 1-12w The second trimester (middle pregnancy): 13-27 w The third trimester (late pregnancy): 28-40w
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. • Amenorrhea is not only due to pregnancy • but also other reasons. • Women of breast feeding may be pregnant • before the recovery of menses.
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 10th to 12th week, its severity varies from mild nausea to persistent vomiting (e.g. Hyperemesis gravidarum).
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.
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.
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.
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 12th week, the fundus of the uterus is usually palpable above the symphysis pubis.
3. 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.
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.
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. • 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.