gyneco

1. 1
Clinical and paraclinical diagnosis of
pregnancy.
M2 2009
Pr. Fomulu / Dr. Nana
27/04/2009

2. 2
Clinical and paraclinical diagnosis of
pregnancy.
 PLAN.
 Introduction- Definition
 Objectives:
 General:
 Student should be able to correctly take the history of a
woman in early pregnancy, identify the symptoms and
signs of pregnancy and investigate to confirm the
diagnosis.

3. 3
Clinical and paraclinical diagnosis of
pregnancy-1
 Specific:
 Name the symptoms of early pregnancy.
 Name the signs of pregnancy.
 Request some laboratory test to confirm the diagnosis of
pregnancy.
 Name some pathological conditions that are associated
with a positive pregnancy test.
nana

4. 4
Clinical and paraclinical diagnosis of
pregnancy-2
 Introduction:
 Fertilisation external 1/3 fallopian tube.
 Zygote divides, moves towards uterine cavity,
implantation.
 Morula, then blastocyst, which consist inner cell mass
and the trophoblast.
 Trophoblast later divides into syncytiotrophoblast and the
cytotrophoblast.
 Syncytiotrophoblast secretes HCG.

5. 5
Clinical and paraclinical diagnosis of
pregnancy-3
 Symptoms of pregnancy:
 Changes early pregnancy affects most systems,
especially, GIT, genito-urinary, nervous, cardio-
respiratory, endocrine, etc.
 Changes consequence of hormonal secretions
associates with pregnancy (oestrogens, progesterone,
HCG, relaxin,).
 Symptoms consist:

6. 6
Clinical and paraclinical diagnosis of
pregnancy-4
 missed period,
 nausea, vomiting, constipation
 Increased frequency urination, vaginal discharge
 Somnolence, sensation of fever
 Palpitation, breast changes(increased, pain heaviness).
 Depending on gestational age, abdominal distension,
weight gain, quickening, colostrum

7. 7
Clinical and paraclinical diagnosis of
pregnancy-5
 Signs of pregnancy
 Parameters normal, but BP decreases in second
trimester.
 Breast- Engorged, hyperpigmented areola, presence
Montgomery´s tubercles.
 Abdomen- depending on GA, distension, hypogastric-
abdominal mass, presence linea nigra, stria gravidarum,
foetal movements, FHT.

8. 8
Clinical and paraclinical diagnosis of
pregnancy-6
 Hyper-vascularised vaginal mucosa, Chadwick´s
sign, softening cervix, uterus increased in
size/soft, corresponding to GA.

9. 9
Clinical and paraclinical diagnosis of
pregnancy-7
 Paraclinical investigations:
• Urine- pregnancy test, urinary excretion HCG
• Blood- beta HCG
• Ultrasonography- As from 6 weeks, embryo, number
gesational sacs,
• Chorionic villi sampling / amniocentesis, specific for
diagnosing certain pathologies complicating pregnancy.

10. 10
Clinical and paraclinical diagnosis of
pregnancy-8
 Pathologies with positive pregnancy test:
• Ectopic pregnancy
• Molar pregnancy / chorio-carcinoma
• Placenta site trophoblastic disease.
• Non-gestational trophoblastic disease complicating
dermoid cyst.
• Tumours-colon.

11. 11
Clinical and paraclinical diagnosis of
pregnancy-9
Conclusion:
Pregnancy test in addition to its importance in the
early diagnosis of pregnancy is useful for the
diagnosis and /or follow-up of a number of
clinical situations in medicine.
nana