These Slides are exclusively prepared for the First Year Post Basic B.Sc. Nursing Students to acquire detail knowledge regarding the Diagnosis of Pregnancy during the First Trimester. Lots of pictures are incorporated into these slides to give a broad & complete knowledge to the Registered Nurses & Midwives to diagnose the pregnancy in the first trimester independently.

1. A VERY GOOD MORNING TO ALL MY
DEAR STUDENTS.

2. NURSING DIAGNOSIS creates a great sense for the
registered Nurse & registered Midwife in the care &
cure of the patient. It helps the Nurse to formulate a
comprehensive care plan for the one who depends on her
for his recovery. Hence, the Midwife must have
knowledge of all domains of Nursing Science in order
to work independently.
A woman moves through various stages
during her journey from birth to death. One of the
most challenging & exciting stage is PREGNANCY which
is meanwhile “The Mother of all hurdles &
uncertainty.”
Hence, this chapter will focus on the
proper management of Pregnancy by using Nursing
Diagnosis.

3. DIAGNOSIS OF PREGNANCY
PRESENTED BY
EMAIL: SAMITDWIBEDICONVIMSARBURLA@GMAIL.COM

4. PREGNANCY ? ? ? ? ? ? ?
gestation

5. HOW DO YOU KNOW ONE (SHE) IS PREGNANT?

6. ❖Nulligravida-
❖Primigravida-
❖Multigravida-

9. ❑Para: - It denotes a state of pregnancy beyond the period of viability.
❖Nullipara- One who has never completed a pregnancy to the stage
of viability.
❖Primipara- One who has delivered one viable child.
❖Multipara- One who has completed two or more pregnancies to the
stage of viability or more.
e.g.- …………!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

10. A woman with a
previous history of
two abortions and one
term delivery can be
expressed as ????

11. “”PRIMIPARA””
✓Parity is not
increased even if the
fetuses are many.

12. ❑POG: - Period of Gestation
❑EDD: - Expected Date of Delivery
❑Conceptional Age: - Age of the fetus calculated from the day of
fertilization.
❑Gestational Age/ Period: - The number of completed weeks of fetal
development calculated from the first day of last menstrual cycle.
❑Parturient: - A woman in labour.
❑Puerpera: - Who has just given birth.
❑Perinatal: - The time surrounding the baby’s birth; denotes a period
between 20 weeks of gestational age to 28 days after birth.

13. ❑Preterm: - Delivered before 37th week
❑Early term: - Delivered between 37th – 38th week and 6 days.
❑Full Term: - Delivered between 39th - 40th weeks and 6 days.
❑Late term: - Delivered at 41st week
❑Post term: - Delivered after 42th week.

14. DURATION OF PREGNANCY
Now a days, pregnancy is usually considered to be as follows: -
❑Days: - 280 days
❑Weeks: - 40 weeks
❑Months: - 9 calendar months and 7 days
The Total Period is divided into 3 trimesters.
❑First trimester- 1st to 12 weeks (12 weeks)
❑Second trimester- 13th to 27th week (15 weeks)
❑Third trimester- 28th to 40th weeks (13 weeks)

15. DIAGNOSIS OF PREGNANCY
Principles of diagnosis:
❑In most of the women, the diagnosis of pregnancy is usually
straightforward based on a history of amenorrhea and a
positive pregnancy test.
❑Women with irregular periods or vaginal bleeding, the
diagnosis of pregnancy is more complex.
❑Other symptoms of pregnancy may alert the clinician to the
possibility of pregnancy.
❑Diagnosis of pregnancy, in the first trimester and early second
trimester, is based on a combination of presumptive &
probable signs of pregnancy.

16. ❑Presumptive/Subjective symptoms of Pregnancy: Maternal
Physiological changes, which the woman experiences and which
indicate her that she is pregnant.
❑Probable/Objective signs of Pregnancy: Maternal Physiological
changes, which are detected upon examination & documented by the
examiner.
❑Positive signs of Pregnancy: Directly attributable to the fetus as
detected & documented by the examiner.

17. CONFIRMED DIAGNOSIS OF PREGNANCY
❑Detection of hCG in either Serum or Urine:
✓Serum hCG is not estimated routinely except after ART (Assisted
Reproductive Techniques).
✓UPT (Urinary Pregnancy Test) can diagnose pregnancy as early as 5
weeks (35 days from LMP) i.e. 7 days after the 1st missed period in
a woman having previous history of regular menstrual cycle.
UPTSPT

18. ❑Detection of gestational sac by Transvaginal
Sonography:
✓TVS can detect a Gestational Sac as early as 5 weeks (35 days from
LMP).
✓Yolk Sac by 37-40 days
✓Fetal Pole with pulsation by 40-45 days.
✓It can Confirm the Pregnancy
• Locate the Site
Determine the No of Fetuses
• Identify any abnormality of Pregnancy

19. Clinical Examination:
✓It implies Bimanual Examination.
✓Diagnose pregnancy as early as 8 weeks in the absence of
any Presumptive symptoms & Probable Signs.

20. PREGNANCY CHANGES DURING THE FIRST
TRIMESTER (FIRST 12 WEEKS)
PRESUMPTIVE/ SUBJECTIVE SYMPTOMS:
Cessation of Menstruation (Amenorrhoea): 4th Week
❑In normally menstruating women, the abrupt cessation of
cyclic and regular periods is strongly suggestive of pregnancy.
❑Cyclic bleeding may occur up to 12 weeks of pregnancy and
is usually scanty, lasting for short duration. It is known as
Placental Sign or Implantation bleeding.
❑Shouldn’t be confused with Threatened Abortion.

21. Morning Sickness (4th – 14th Week):
❑More often seen in first pregnancy than subsequent one.
❑Usually appears soon following the missed period & rarely lasts
beyond the first trimester.
❑Intensity varies from nausea on rising from the bed to loss of
appetite or even vomiting.

22. Frequency of Micturition (6th – 12th Week):
❑It is due to:
➢The pressure from the enlarging gravid uterus on the fundus of the
bladder
➢Congestion of the bladder mucosa
❑This symptom is relieved when the growing uterus becomes an
abdominal organ.
❑It again returns towards full term when the fetal head engages in the
pelvis.

23. Breast Discomfort (6 – 8 Weeks):
❑Usually seen in primigravida.
❑Feeling of fullness & Pricking Sensation in the breasts.

24. Fatigue (4th Weeks onwards):
❑Tiredness is an early symptom.
❑Some women complain of sleepiness
and disinclination to work.

25. Feeling of warmth and sweating:
❑Some women complain of feeling
feverish and excessive sweating.
❑This is usually due to altered circulation
in the skin.

26. Objective/Probable Signs:
❑Breast Changes (6 – 8 Weeks): -
➢Enlargement of breasts along with vascular
engorgement evidenced by the delicate veins
visible under the skin.
➢Increase pigmentation of
nipple & areola (primary).

27. ➢Montgomery’s tubercles (sebaceous
or oil glands that appear as small bumps
around the dark area of the nipple)
are prominent.
➢Their primary function is lubricating and
keeping germs away from the breasts.
➢Secretion of colostrum by 12th week.

28. ❑ Per Abdomen:
➢Uterus remains a pelvic organ until
12th week.
➢It may be just felt per abdomen as
a suprapubic bulge.

29. ❑ Pelvic Changes:
➢Jacquemier’s or Chadwick’s Sign:
❖Dusky hue of the vestibule & anterior vaginal
wall by 8th week of pregnancy.
❖It is due to local vascular changes.

30. ❑ Vaginal Sign:
➢Soft anterior vaginal wall
➢Copious non-irritating mucoid discharge by 6th
week
➢It is due to increased hormones level and vaginal
blood flow.
➢Increased pulsation in the lateral fornices by
8th week (Osiander’s Sign).

31. ❑ Cervical Signs:
➢Cervix becomes soft around
6th week (Goodell’s Sign).
➢Cervix feels like the lips of the mouth.
➢Bluish discolouration of the cervix
found on speculum examination.

32. ❑ Uterine Signs:
➢Size: -
❖Hen’s Egg at 6th Week
❖Cricket Ball at 8th Week
❖Fetal Head at 12th Week
➢Shape: - Globular at 12th Week
➢Consistency: -
❖One half is more firm than the other half (Piskacek’s Sign).
❖Uterus feels soft & elastic.

33. Hegar’s Sign:
➢Upper part of the body of the uterus is
enlarged by the growing fetus
➢Lower part is of the body is empty &
extremely soft
➢Cervix is comparatively firm.
This can be elicited by Bimanual Examination where the abdominal
& vaginal fingers seem to appose below the body of the uterus.

34. Palmer’s Sign:
➢Regular & rhythmic uterine contraction as early as 4-8 Weeks.
➢Can be elicited by Bimanual Examination: -
❖Where the uterus is cupped between internal & external fingers for
2-3 minutes
❖During contraction, uterus becomes firm & well defined
❖Soft & ill defined during relaxation.

35. Special Investigation: -
❑Detection of hCG: -
➢UPT is the commonly used lab test to detect pregnancy.
➢It detects the Beta-Sub unit of hCG in as low as 25 IU/L of Urine.
➢Serum quantitative tests are more reliable & accurate, but are
expensive & rarely used in ART to assess the growth of fetus or to
rule out any abnormality during pregnancy.

36. High Resolution Ultrasonography:
➢Detection of Gestation Sac, its location & number is generally
possible as early as the 5th week of gestation on TVS.
➢TVS can detect Fetal Viability & Gestational Age as follows:
❖Gestational Sac by 5th Weeks
❖Fetal Pole & Cardiac Activity by 6th Weeks
❖Embryonic Movements by 7th Weeks
❖Fetal Gestational Age by measuring the CRL between 7-12
Weeks
➢Doppler USG can detect Fetal Heart Rate (FHR) by 10th
Weeks.

37. Ultrasonography:
CRL MEASUREMENT

38. Q: How can you
diagnose a
pregnancy in
early weeks as a
Midwife ?