Diagnosis Of Pregnancy


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

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Diagnosis Of Pregnancy

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