Diagnosis Of Pregnancy
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Diagnosis Of Pregnancy

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Diagnosing Pregnancy by Physical examination , home tests, lab investigations and sonography

Diagnosing Pregnancy by Physical examination , home tests, lab investigations and sonography

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Diagnosis Of Pregnancy Diagnosis Of Pregnancy Presentation Transcript

    • - Dr. Neelesh Bhandari
    • M.B.B.S (AFMC), M.D. (Path)
    • P.G.P in Human Rights.
    Diagnosis of Pregnancy
  • Early pregnancy detection allows
    • the commencement of prenatal care,
    • potential medication changes,
    • lifestyle changes to promote a healthy pregnancy (appropriate diet; avoidance of alcohol, tobacco, and certain medications),
    • early pregnancy termination if so desired .
  • Pregnancy can be diagnosed by 3 approaches.
    • Physical examination
    • Laboratory evaluation
    • Ultrasonography
    • Early Physical signs of pregnancy
    • Blue discoloration of the cervix and vagina ( Chadwick's sign )
    • Softening of cervix ( Goodell's sign )
    • Softening of uterus ( Ladin's sign and Hegar's sign )
    • Darkening of the nipples
    • Unexplained pelvic or abdominal mass
    • Breast and nipple tenderness
    • Nausea
    • Urinary frequency
    Physical signs of pregnancy…
    • The most commonly used assays are for the beta subunit of hCG
    • Other hormones that have been used for diagnosis-
    • progesterone
    • early pregnancy factor (EPF).
    Laboratory Investigations
    • This hormone is only released by trophoblastic tissue produced by a growing fetus and its associated placenta.
    • hCG is present in the maternal circulation as either an intact dimer, alpha or beta subunit, and degraded form, or beta core fragment
    • Detection of HCG in maternal serum and urine is evident only 8-10 days after conception
    HCG
    • hCG is detectable in the serum of approximately 5% of patients 8 days after conception and in more than 98% of patients by day 11
    • Diagnostic levels in Urine seen only about 23-24 days after conception.
    • Levels peak at 10-12 weeks' gestation and then plateau before falling
    HCG...
  • In general, the HCG level will double every two to three days in early pregnancy
    • Detects presence of HCG in Urine sample.
    • Easy to perform.
    • Inexpensive compared to Blood tests
    • Most current pregnancy tests have sensitivity to
    • approximately 25 to 35 mIU/mL
    • ( ranges from 25 to 100mIU/mL ) .
    • .
    Home Pregnancy Tests- After 3 drops of urine are placed in the "S" basin, a sold line appears at the "C" area. After a minute, another line appears at the "T" area, indicating that this patient is pregnant.
    • Home Pregnancy Tests
    • kits available for hCG detection in urine via
    • - Direct Latex agglutination and/or
    • - Indirect Agglutination inhibition tests.
    • HPTs are most commonly used in the week after
    • the missed menstrual period
    • (fourth completed gestational week).
    • Urine hCG values are extremely variable at this
    • time and can range from 12 to 2500 mIU/mL.
    • Currently, 4 main hCG assays are used,
    • radioimmunoassay,
    • immunoradiometric assay,
    • enzyme-linked immunosorbent assay (ELISA),
    • fluoroimmunoassay.
    Blood tests for HCG
    • Used only in special cases
    • ( bad obstetric history, suspicion of ectopic,etc.)
    • Require special labs and expertise .
    • Radioimmunoassay
      • Sensitivity - 5 mIU/mL
      • Time to complete - 4 hours
      • Postconception age when first positive - 10-18 days
      • Gestational age when first positive - 3-4 weeks
    • Immunoradiometric assay (more sensitive)
      • Sensitivity - 150 mIU/mL
      • Time to complete - 30 minutes
      • Postconception age when first positive - 18-22 days
      • Gestational age when first positive - 4 weeks
    • Immunoradiometric assay (less sensitive )
      • Sensitivity - 1500 mIU/mL
      • Time to complete - 2 minutes
      • Postconception age when first positive - 25-28 days
      • Gestational age when first positive - 5 weeks
    Blood tests for HCG...
    • Enzyme-linked immunosorbent assay (more sensitive)
      • Sensitivity - 25 mIU/mL
      • Time to complete - 80 minutes
      • Postconception age when first positive - 14-17 days
      • Gestational age when first positive - 3.5 weeks
    • Enzyme-linked immunosorbent assay (less sensitive)
      • Sensitivity - Less than 50 mIU/mL
      • Time to complete - 5-15 minutes
      • Postconception age when first positive - 18-22 days
      • Gestational age when first positive - 4 weeks
    • Fluoroimmunoassay
      • Sensitivity - 1 mIU/mL
      • Time to complete - 2-3 hours
      • Postconception age when first positive - 14-17 days
      • Gestational age when first positive - 3.5 weeks
    Blood tests for HCG...
    • Failure to achieve the projected rate of rise
    • ( slow rise ) may suggest an ectopic
    • pregnancy or spontaneous abortion.
    • On the other hand, an abnormally high level
    • or accelerated rise can prompt investigation
    • into the possibility of
    • molar pregnancy,
    • multiple gestations,
    • chromosomal abnormalities.
  • False-positive hCG
    • Phantom hCG - Rule out with sensitive urine assay, as these antibodies do not cross into urine
    • Pituitary hCG - Diagnosed by administering oral contraceptive pills, which should suppress hCG levels
    • Exogenous administration of hCG
    • Trophoblastic neoplasm – e.g. Choriocarcinoma
    • Nontrophoblastic neoplasm - Can be secreted by different cancers, (e.g., testicular, bladder, uterine, lung, liver, stomach )
    Most false-positive results are characterized by serum levels that are generally less than 1000 mIU/mL and usually less than 150 mIU/mL
    • usually involve urine and are due to the qualitative nature of the test. Reasons include –
    • an hCG concentration below the sensitivity threshold of the specific test being used.
    • a miscalculation in the onset of the missed menses,
    • delayed menses from early pregnancy loss.
    • Delayed ovulation or delayed implantation .
    False-negative hCG
    • Measurement of serum progesterone is inexpensive
    • Done by Radioimmunoassay and Fluoroimmunoassay
    • Can reliably predict pregnancy prognosis.
    Serum progesterone A dipstick ELISA that can determine a S.Progesterone level of less than 15 ng/mL is also on the market.
    • ELISA is helpful as a screening tool for at risk populations because progesterone levels of greater than 15 ng/mL make ectopic pregnancy unlikely.
    • Serum progesterone levels greater than 25 ng/mL Viable Intrauterine Pregnancy
    • Serum progesterone levels of less than 5 ng/mL Nonviable pregnancy .
    Serum progesterone...
    • Early pregnancy factor
    • Earliest available marker to indicate fertilization
    • (detectable 36-48 hours after fertilization).
    • Peaks early in first trimester, almost undetectable
    • at term.
    • Appears within 48 hours of successful
    • IVF embryo transfers.
    • Vanishes 24 hours after delivery
    • (or at the termination of pregnancy)
    • Detected by rosette inhibition test .
    • .
    • Ultrasound
    • The identification of gestational structures
    • by US correlates with specific levels of hCG, termed
    • discriminatory levels .
    • A discriminatory level is the level of hCG at which
    • the structure in question should always be identified.
    • Most experienced TVUS operators should visualize
    • the GS when levels are approximately 1000 mIU/mL.
    • The discriminatory level for the GS is approximately
    • 3600 mIU/mL, and if it is not seen at this point,
    • other pathology must be excluded.
    GS – Gestational Sac
    • The yolk sac is commonly observed with
    • an hCG level of approximately 2500 mIU/mL,
    • The embryonic pole usually becomes evident
    • at a level of approximately 5000 mIU/mL,
    • Fetal heartbeat can be seen in the vast
    • majority of normal gestations when the hCG
    • level reaches 10,000 mIU/mL.
  • Take Care. [email_address]