Detail Ppt of Diagnosis of Pregnancy

1. DIAGNOSIS OF PREGNANCYDIAGNOSIS OF PREGNANCY

2. Reproductive period of women begins at menarche &
ends in menopause
I:e 13 to 45 yrs

3. Duration of pregnancy
10 Lunar months / 9 Calendar months 7days
280 days / 40 wks

4. Calculated from first day of last menstrual period
Called as menstrual age / GA
Fertilization age – 266 days
Ovulation – 266 days

5. Subjective Symptoms
Amenorrhoea
Missing of period
Morning sickness
Present in 50% of cases
Nausea / Vomiting / Loss of appetite

6. Frequency of urine
Pressure of enlarged uterus on bladder
Congestion of bladder mucosa
Breast discomfort / Giddiness / Fatigue

7. Breast
Nipple / areola – pigmented
Montgomery’s tubercles prominent

8. PA - Uterus not palpable
Jaequemier’s sign / Chadwick's sign
Bluish colouration of vagina – local vascular
congestion
Nonirritating mucoid discharge
 vascularity

9. Goodell’s sign
Cx softened - vascularity
Uterus enlarged, soft , elastic
Hegar’s sign
Softened interned os

10. Palmer’s sign
Regular & rhythmic uterine contractions during
bimanual Cx

11. Immunological tests for diagnosis of preg
Principle
Detection of hCG antigen in maternal urine & serum
Various kits available

13. Gravindex test – slide test
Put one drop of urine on the slide
If one line present - not pregnant
If two lines present - pregnant

15. Selection of time
8 to 11 days after conception
i:e within a wk after missing of period
Not reliable after 12 wks

16. Collection of urine
First voided urine in the morning
Container not to be washed with soap

17. Uses of preg tests
To confirm intra uterine pregnancy
To diagnose ectopic pregnancy
To monitor or follow up molar pregnancy & chorio
carcinoma

18. Test accuracy
 98.6 to 99%
Non preg level – 1 mIU / ml
Limitations – Accuracy affected, due to
Haemoglobin, Albumin, LH, Immunological diseases

19. Advantages
Simple / speed / accuracy / less cost

20. USG
Intra uterine gest sac + Yolk sac - 5th
wk
Foetal pole, cardiac activity – 6 wks
Embryonic movements – 7 wks
GA – 7 & 12 wks

21. Symptoms
Quickening
Perception of active foetal movements – 18 wks
Progressive enlargement of uterus

22. Signs
Chloasma – pigmentation over forehead –
checks – 24 wks
Breasts – enlarged with prominent veins

23. Secondary areola – 20 wks
Montgomery tubercles over secondary areola
Colostrum – thick & yellowish – 16 wks
Linear pigmented line – linea nigra & striae - 20 wks

25. Striae
Both pink & white

26. Fundal height – increased progressively
Just palpable – 14 wks
Between symphisis & umbilicus – 16 wks
At umbilicus – 24 wks

28. Xiphi sternum – 36 wks
3 fingers above – umbilicus – 28 wks
6 fingers above – umbilicus – 32 wks

29. Palpation foetal parts – 20 wks
Active foetal movements – 20 wks
External ballottement – 20 wks

31. Fetal Heart Sounds
Auscultation of FHS – 18 to 20 wks
120 – 160 beats per min / over – 140
Uterine soufflé
Systolic murmur synchronous with maternal pulse
due increased blood flow through dilated uterine
vessels

33. Funic or foetal soufflé
Rush of blood through umbilical arteries – soft,
blowing murmur synchronous with foetal heart
sounds

34. Investigations
Sonography – 18 to 20 wks
detailed exam for foetal anatomy, placental
localization, integrity of Cx canal

35. For GA
BPD / HC / AC / FL
MRI : To rule out anomalies
X- ray – foetal skeleton – 16th
wk

36. Amonorrhoea persists
Progressive enlargement of abd

37. Lightening at 38 wks – Shelving sign
Falling forward of ut
Engagement of presenting part
 Liquor

38. Foetal movements / FH Sounds present
Foetal parts
FHS not heard – IUD / obesity / polyhydramnios
Sonography

39. Differential diagnosis
Abdomino pelvic mass
Distended bladder
Uterine fibroid
Cystic ovarian tumour
Encysted tubercular peritonitis
Haematometra