antenatal diagnosis

1. Rajani
M.Sc.Nursing Pre. Year
Batch 2020
Govt. College of Nursing, jodhpur
DIAGNOSIS OF PREGNANCY

2. Introduction -
 Antenatal diagnosis
of pregnancy
include –
1. Presumptive signs
2. Probable signs
3. Positive signs

8.  FIRST TRIMESTER(FIRST 12
WEEKS)
A. SUBJECTIVE SYMPTOMS -
 AMENORRHOEA
 MORNING SICKNESS(FIRST
TRIMESTER)
 FREQUENCY OF MICTURATION(8-12
WKS)
 BREAST DISCOMFORT ( 6-8 WKS )

9. B. OBJECTIVE SIGN
1. BREAST CHANGES (6-8WEEKS)
Breast enlargement with vascular
engorgement.
Nipple and areola become more
pigmented.
Colostrum can be expressed as
early as 12th week.
Montgomery’s tubercles are

11. 2. PELVIC CHANGES -
JACQUEMIER’S SIGN (8WKS)
OSIANDER SIGN
GOODELL’S SIGN
UTERINE SIGN
HEGAR’S SIGN
Uterus remains a pelvic organ
until 12th week, then it may be felt
per abdomen as a suprapubic

12. i. CHADWICK’S SIGN -
 ON SPECULUM INSPECTION –
CERVIX & VAGINA APPEAR
BLUISH OR PURPLISH
DISCOLORATION DUE TO
VASCULAR CONGESTION AT
ABOUT 8TH WEEK OF
PREGNANCY.

13. ii. OSIANDER’S SIGN ( vaginal
signs )
 BLUISH DISCOLOURATION OF THE
ANTERIOR VAGINAL WALL
 COPIUS NON IRRITATING MUCOID
DISCHARGE APPEARS AT 6TH WEEK
 INCREASE PULSATION FELT THROUGH
THE LATERAL FORNICES AT 8TH WK.

14. iii. GOODELL’S SIGN ( cervical
signs)
Appears at 6th week

15. iv. UTERINE SIGN -
 HEN’S EGG 6TH WK
 CRICKET BALL 8TH WK
 FETAL HEAD 12 WK
 SHAPE – BECOMES GLOBULAR AT 12
WKS FROM PYRIFORM.
 CONSISTENCY – BECOMES SOFT &
ELASTIC.

16. v. HEGAR’S SIGN
 (6-8WKS)
 UPPER PART OF
THE BODY OF THE
UTERUS IS
ENLARGED BY
THE GROWING OVUM
 LOWER PART OF
THE BODY IS EMPTY
AND EXTREMELY SOFT.
 CERVIX IS COMPARATIVELY FIRM.

17. C. Immunological tests for diagnosis of
pregnancy

18. PREGNANCY TEST
SUMMARY OF PREGNANCY TEST
TEST SENSITIVIT
Y HCG
(IU/ML)
TIME
TAKEN
INFERENCE POSITIVE ON
IMMUNOLOGICAL TEST
SLIDE TEST
1.5-3.5 2MIN NO AGGLUTINATION 42 DAYS AFTER LMP
BETA GRAVINDEX SLIDE
TEST
0.5-1 2MIN ABSENCE OF
AGGLUTINATION
2 DAYS AFTER MISSED
PERIODS
PREG COLOR TEST 1.5-2 0MIN TURNS COLOURLESS 2 DAYS AFTER MISSED
PERIODS
DIRECT LATEX
AGGLUTINATION TEST
0.2 2MIN PRESENCE OF
AGGLUTINATION
2 -3DAYS AFTER MISSED
PERIODS
ELISA 0.02-0.05 4-5MIN BLUE LINE IN THE
CONTROL AS WELL AS
IN RESULT WINDOW
28TH DAYS OF CYCLE
RAIOIMMUNOASSAY 0.002 3-4HRS 25TH DAY OF THE CYCLE
RADIO RECEPTOR ASSAY 0.001 1HR 22ND DAY OF CYCLE

19. Cont..
Time -8-11 days after conception. The test is not
reliable after 12 weeks.
Collection of urine -First voided urine in the
morning in a clean container.
Other uses of pregnancy tests
 To Diagnosis of ectopic pregnancy
 Monitoring pregnancy following IVF and embryo
transfer
 Follow-up of cases of hydatidiform mole and
choriocarcinoma.
Limitations - Test accuracy is affected due to
presence of haemoglobin, albumin, LH and
immunological diseases.

22. D. ULTRA-SONOGRAPHY

23. identified on 29 to 35 days of
gestation.

24. Cont…
 FETAL VIABILITY IS DETERMINED BY
DETECTING THE FOLLOWING
STRUCTURE BY TVS –
i. GESTATIONAL SAC AND YOLK SAC BY 5
WEEKS.

25. Cont…-
ii. FETAL POLE AND CARDIAC
ACTIVITY BY 6 WEEKS.

26. Cont...
EMBROYONIC MOVEMENTS BY 7
WEEKS

27. Cont..
 DOPPLER ULTRASOUND CAN PICK UP THE
FETAL HEART RATE RELIABLY BY 10TH
WEEK.
 FOETAL GESTATIONAL AGE IS BEST
DETERMINED BY MEASURING CRL
BETWEEN 7-12 WEEKS.

28. Second trimester (13 to 28
weeks)
A. Subjective symptoms –
• Nausea, vomiting and frequency of
micturation usually subside.
• Quikening –
- between 18 to 20th weeks in
primigravidae
- between 16 to 18th weeks in
multigravidae
• Progressive enlargement of lower

29. B. Objective signs -
General examination –
1. Face - ( At 24th weeks)

30. 2. Breast changes-
More enlarged with prominent veins
under the skin.
Secondary areola appears at 20th
weeks.
Montgomery’s tubercle are prominent
and extend to the secondary areola.
Colostrum becomes thick and
yellowish by 16th week.
Variable degree of striae may be

31. •ABDOMINAL EXAMINATION -
a. INSPECTION
b. PALPATION
c. AUSCALTATION

32. •Abdominal examination-
a. Inspection –
• linea nigra becomes visible at 20th weeks.
• Striae (both pink & white) of varying degree are
visible in the lower abdomen.

33. b. Palpation -
 Approximate duration of pregnancy can be
estimate by noting the fundal height in
relation to different level of the abdomen.

35. Cont...
Braxton-hicks contraction are evident.
Palpation of fetal part by 20th weeks.
Active fetal movement
can be felt by placing
hand over the uterus.
External ballotment
is usually elicited.

38. c. Auscaltation -
FHS is most conclusive sign of
pregnancy.
With an ordinary stethoscope, it can be
detected between 18 to 20 weeks.
The rates varies from 140-160 bpm but
gradually settles down to 120-140 bpm
as pregnancy advanced.
Two other sounds confused with FHS are
:

39. • Vaginal examination -
a. Bluish discolouration of vulva,
vagina & cervix.
b. Increased softening of the cervix.

40. C. Ultrasonography -
At 18-20 weeks, routine
sonography diagnose about-
Foetal anatomy to detect any
malformation.
Placental localisation
Integrity of cervical canal
To determine gestational age by
measuring BPD, AC, FL,HC with
more accuracy in 2nd trimester.

41. D. Foetal skeletal shadow may
be visible at 16 week by
radiological evidence but this
diagnosis is not undertaken.

42. Third trimester (29 to 40 weeks)
A. Subjective symptoms -
Some mechanical discomfort such
as palpitation, dyspnea, heart burn
produce from early third trimester.
• Lightening occur at about 38th week.
• Frequency of micturition reappears
after lightening.
• Foetal movements are more
pronounced.

43. B. Objective signs -
 Cutaneous changes are more prominent
with increased pigmentation.
 Uterine shape is changed from cylindrical to
spherical beyond 36 week.
 Braxton hicks contraction are more evident.
 Foetal movements are easily felt.
 Palpatation of the foetal parts and their
identification become much easier.
 FHS is heard distinctly in areas
corresponding to the presentation &
position of the foetus.

44. Cont...
• FHS is not be audible in case of-
Maternal obesity
Polyhydramnios
Occipito-poterior position and IUD
• Fundal height –
The distance between the umbilicus and the
ensiform cartilage is divided into 3 equal part.

45. C. Ultrasonography -
Gestational age estimation by
BPD, HC, AC and FL is less
accurate .
Amniotic fluid assessment is
done to detect fetal well being.
If AFI is < 5=oligohydramnios or
If AFI is > 25=polyhydramnios.
To detect placental anatomy.

46. DIFFERENTIAL DIAGNOSIS
PSEUDOCYESIS
CYSTIC OVARIAN TUMOUR
FIBROID
ENCYSTED PERITONITIS
DISTENDED URINARY
BLADDER

47. SIGNS OF PREVIOUS
CHILDBIRTH
BREAST
ABDOMINAL WALL
UTERINE WALL
PERINEUM
INTROITUS
VAGINA

48. AGE & EXPECTED DATE OF
DELIVERY -
DATE OF FRUITFUL COITUS
NAEGELE’S FORMULA
DATE OF QUICKENING

49. THAN
K
YOU.

50. MINOR ALIGNMENTS IN
PREGNANCY
 NAUSEA AND VOMITTING
 BACKACHE
 CONSTIPATON
 LEGCRAMPS
 ACIDITY AND HEART BURN
 VERICOSE VEIN
 ANKLE OEDEMA