Signs and Symptoms, Investigations-UPT and USG helps to diagnose pregnancy. A midwife can diagnose pregnancy by physical examination of signs and symptoms.

1. PREPARED BY:
Srujani Swetasina Dash
Nursing Tutor
G.N.M. Institute
A.N.M.M.C.H, GAYA

2. Definition and Duration of Pregnancy
Diagnosis of Pregnancy
Symptoms of Pregnancy
Signs of Pregnancy
Laboratory investigation using testing kit
Ultrasonography
Evaluation and Answer Key
Assignment
Bibliography

3. Pregnancy is a
physiological process in
which the single celled
zygote is implanted in
the uterus and
developed within the
uterus.

4. Clinically, it is the period from the 1st day of
LMP to onset of true labour pain.
Duration: 9 months and 7 days
280 days
40 weeks
Pregnancy is divided into 3 trimesters-
1st Trimester- 0-12 weeks
2nd Trimester- 13-28 weeks
3rd Trimester- 29-40 weeks

5. SIGNS & SYMPTOMS
INVESTIGATIONS
USG

7. SYMPTOMS SIGNS
 Amenorrohoea
 Morning Sickness
 Frequency Micturition
 Breast Discomfort
 Fatigue
 Breast Changes
 Abdominal Sign
 Vaginal Sign
 Cervical Sign
 Uterine Sign

8. SYMPTOMS SIGNS
 Amenorrohoea
 Quickening
 Breast Changes
 Abdominal Sign
 Cutaneous Sign
 Vaginal &Cervical Sign
 Uterine Sign
 Palpation of fetal parts
 Active Fetal Movements
 FHS

9. SYMPTOMS SIGNS
 Amenorrohoea
 Palpitation & Dyspnoea
 Lightening
 Frequency Micturition
 Active Fetal movements
 Breast Changes
 Abdominal Sign
 Cutaneos Sign
 Vaginal &Cervical Sign
 Uterine Sign
 Palpation of fetal parts
 Active Fetal Movements
 FHS

11. Amenorrhoea/Missed
period
 Cessation of menstruation.
 Continues until labour and
delivery
Missed period

12. Morning sickness
 Nausea or vomiting on
rising from bed
 Starts in early
pregnancy from 4-14
weeks
 Gets better during the
day
 Subsides in the second
trimester after 12-14
weeks
 Does not generally
affects the health of
mother.

13. Frequency of Micturition
 Occur during early pregnancy from 8-12 weeks
 Due to resting of bulky uterus on the bladder
 Subsides after 12 weeks and recurs in late
pregnancy after 36 weeks until initiation of labour

14. Breast Discomfort
 Occur during early pregnancy from 6-8
weeks
 Feeling of fullness and pricking sensation
Fatigue
 Occurs early in pregnancy and lasts usually
upto 1st trimester.
 Feeling of tiredness

15. Quickening
 Starts in mid-
pregnancy from 16-20
weeks onwards
 First feeling of the fetal
movements
 Earlier in multigravida
 Little late in
primigravida

17. Breast Changes
 Start from 6-8 weeks continue until
delivery
 Growth and enlargement
 Tenderness and hypersensitivity
 Nipples becomes larger, erectile
and deeply pigmented and areolas
becomes more pigmented.
 Secondary areola appears at
about 20th week.
 Darkened veins along the breasts
 Montgomery’s tubercles formed by
hypertrophy of sebaceous gland.
 Thick yellow secretions
(colostrum) can be expressed as
early as 12- 16th week.

18. Enlarging abdomen
 12 weeks onwards
 Uterus is felt suprapubic
bulge until 12 weeks
 Obvious sign of fetal growth.
 Fundal height can me
measured per abdomen as it
enlarges.

19. Chadwick’s sign / Jacquemier’s
sign
 Dark purplish red discoloration and
congestion of the vulva and vaginal
mucosa
 8 weeks onwards
 Non irritating mucoid discharge
appears at 6th week.
Osiander sign
 Increased pulsation of vagina felt
through lateral fornices.
 8 weeks onwards
 Caused by greatly increased blood
supply to the uterrus and enlarged
uterine artery

20. Goodells Sign
 Cervix becomes more
softer
 Evident at 6th week

21. Size
 6th week- Hen’s Egg
 8th week- Cricket Ball
 12th week- Fetal Head
Consistency
 Soft and Elastic
Shape
 12th week- Globular
 28th week- Ovoid
 36th week- Spherical

22. Braxton Hicks
contractions
 Start in mid-pregnancy 16
weeks onwards
 Appear and disappear
spontaneously
 Irregular, infrequent,
spasmodic and painless
contractions without effect
on cervical dilatation
 May feel like mild cramps

23. Hegar’s sign
 From 6-12 weeks
 On bimanual
examination, the fingers
oppose below the body
of uterus
 Due to soft uterine
isthmus and enlarged
upper part

24. Piskacek’s Sign
One half of uterus
is more firm than
the other half.
Palmer’s Sign
 Regular and
rhythmic uterine
contraction can be
elicited during
bimanual
examination as early
as 4-8th week.
 Cannot elicited after
10th week.

25. Fundal Height
 Increased with enlargement of uterus.
 Helps in estimation of gestation age by
noting the height of the uterus in
relation to different levels in the
abdomen.
weeks in relation to abdomen
12th wks- at level of symphysis pubis
16th wks- at lower 1/3rd distance between
symphysis pubis and umbilicus
20th wks- at lower 2/3rd distance between
symphysis pubis and umbilicus
24th wks- at level of umbilicus
28th wks- at lower 1/3rd distance between
umbilicus and xiphi sternum
32nd wks- at lower 2/3rd distance between
umbilicus and xiphi sternum
36th wks- at level of xiphi sternum
40th wks- at lower 1/3rd distance between
umbilicus and xiphi sternum

26. Skin changes
 Chloasma
Gravidarum
 Pigmentations on
the face and
abdomen
 Start 8 weeks
onwards and stay
throughout the
pregnancy
 Appear first on the
face

27. Skin changes
 Linea nigra
 Extends from the
symphysis pubis to the
umbilicus
 Later extends up to the
xiphi sternum
 Visible at 20th week and
remains.

28. Skin changes
 Striae gravidarum
occur in mid and late
pregnancy
 Silvery white stripes
are seen in the
abdomen extending
to the thighs

29. Fetal parts palpable
 Palpation of fetal parts
can be elicited.
 From 24 weeks more
distictly.

30. Fetal movements palpable
 22 weeks onwards
 Earlier in multigravida
 Visible in late pregnancy
 More prominent in a thin built
woman
 Foot visible

31. Auscultation of the
fetal heart sound
 11-12 weeks
onwards by Doppler
 24 weeks onwards
by using a
stethoscope or
fetoscope kept on
the women’s
abdomen

32. Funic/ Fetal souffle
 Due to rush of blood
through umbilical
arteries.
 Sound is synchronous
with FHS
Uterine soufflé
 Due to passage of
blood through dilated
vessels
 Sound is synchronous
with maternal pulse.

34.  Presence of HCG in the blood from 9-10 days
 Presence of HCG in the urine from 14 days
onwards

36. Visualization of
gestational sac by
ultrasound (USG)
 From 4-5 weeks (29-35 days of
gestation)
 Confirms pregnancy
Visualization of the heart
pulsations by USG
 5-6 weeks onwards.
 Movement of the heart valves
can be seen.

37. •Pregnancy is a crucial period for every woman as many
physiological changes takes place during this period.
•Pregnancy can be diagnosed by :
 History taking for symptoms
 Physical examination for signs
 Tests for confirmation
Laboratory tests
Ultrasonography
SUMMARY

38. All the signs and symptoms of pregnancy were broadly
classified into 3 signs:
i. Positive or Absolute signs
ii. Probable Signs
iii. Presumptive Signs

39. Positive Probable Presumptive
Palpation of fetal
parts
Abdominal
Enlargement
Amenorrhoea
Perception of active
fetal movements
Braxton hicks
Contraction
Frequency of
Micturition
Auscultation of FHS Outlining of fetus Morning Sickness
USG evidence of
embryo
Changes in shape,
size consistency of
uterus
Fatigue
Radiological
Demonstration of
fetal skeleton at 16th
week onwards
Jacquemiers Sign Breast Changes
Goodell’s sign Skin Changes
Osiander Sign Quickening
Lab Test
External and
Internal Ballotment

40. Prepare notes on Diagnosis of pregnancy

41. Dutta D.C. “Textbook of Obstetric”
Jacob Annama, Textbook of Midwifery and
Gynaecological Nursing”.
Kaur Sandeep, “Midwifery and
Gynaecological Nursing

42.  When can we auscultate the fetal heart sounds with a
fetal stethoscope?
 When can we palpate the fetal parts?
 Pregnancy testing kit–Nishchay detects the presence of
which hormone in the urine?