This document discusses diagnosis of pregnancy across the three trimesters. It covers early signs of pregnancy like amenorrhea and morning sickness. Diagnostic tests include urine and blood pregnancy tests and ultrasound to detect the gestational sac. For mid-late pregnancy, signs include uterine growth and fetal movement. Ultrasound can monitor fetal growth and check for abnormalities. Fetal positioning including lie, presentation, and position are also discussed.

1. Diagnosis of PregnancyDiagnosis of Pregnancy

2. 2
Review
 Pregnancy (gestation)Pregnancy (gestation)
 Fetal Growth And DevelopmentFetal Growth And Development
 Fetal appendage
 Maternal physiology during pregancyMaternal physiology during pregancy

3. 3
Multiple choice questionsMultiple choice questions
Hormone X is secreted in the follicular phase and areHormone X is secreted in the follicular phase and are
responsible for suppressing FSH in the late follicular phase priorresponsible for suppressing FSH in the late follicular phase prior
to ovulation. What is hormones X ?to ovulation. What is hormones X ?
(A) LH(A) LH
(B) FSH(B) FSH
(C)(C) progesteroneprogesterone
(D) estrogen(D) estrogen
(E) testosterone(E) testosterone

4. 4
• Female, 25 years old, married, normalFemale, 25 years old, married, normal
menstrual cycle, not contraception,menstrual cycle, not contraception,
• the first day of the last menstrualthe first day of the last menstrual
period (LMP) is 2011/01/20period (LMP) is 2011/01/20
• Now she come to ……Now she come to ……
How consider about ?How consider about ?
If you are a doctor inIf you are a doctor in clinic…………

5. 5
cessation menstruationcessation menstruation
First
trimester
ectopic
DUB PCOSPCOS
Impuberal
post-
menopause
GTD lactation
General
disease
neoplasms

6. 6
Diagnosis ofof pregnancy

7. 7
Diagnosis ofof pregnancy
 almost the most important in women life to othersalmost the most important in women life to others
 Medical doctors have the knowledge aboutMedical doctors have the knowledge about
pregnancy important ,pregnancy important ,no matter how the practice characteristics andno matter how the practice characteristics and
professionalprofessional
 Whether she was pregnant ?Whether she was pregnant ?
 Incorret diagnosis and inappropriateIncorret diagnosis and inappropriate
treatment →treatment →judicial interventionjudicial intervention

8. 8
The Whole Period of Pregnancy DividedThe Whole Period of Pregnancy Divided
Into Three Stages:Into Three Stages:
The whole process of pregnancy from the first day of the last menstrual period (LMP) with an average 280 days, 40
weeks
 The first trimester (early pregnancy): 1-12wThe first trimester (early pregnancy): 1-12w
 The second trimester (middle pregnancy): 13-27 wThe second trimester (middle pregnancy): 13-27 w
 The third trimester (late pregnancy): 28-40wThe third trimester (late pregnancy): 28-40w

9. 9
Diagnosis of Early PregnancyDiagnosis of Early Pregnancy
 History and symptomsHistory and symptoms on the basis of a historyon the basis of a history ，， enlarging uterus and a positiveenlarging uterus and a positive
pregnancy test.pregnancy test.
1.1. AmenorrheaAmenorrhea
The first and the most important symptomThe first and the most important symptom with regular menstrual cycles
 emotional tension, chronic disease , certain medicationsemotional tension, chronic disease , certain medications
genitourinary tumorsgenitourinary tumors → delayed menses→ delayed menses
 Differential Diagnosis ： lactation, oral contraception,lactation, oral contraception,
endocrine disorder

10. 10
Diagnosis of Early PregnancyDiagnosis of Early Pregnancy
2. Morning sickness2. Morning sickness
 Nausea and vomitingNausea and vomitingoccurs in about 50% of pregnancies.occurs in about 50% of pregnancies. (the 6(the 6thth
weekweek↑↑ →→
the 12the 12thth
weekweek↓↓ ))
 Causes: HCG, delayed gastric emptying(PCauses: HCG, delayed gastric emptying(P↑↑ ))

11. 11
Diagnosis of Early PregnancyDiagnosis of Early Pregnancy
3.3. Urinary symptomsUrinary symptoms
 Bladder irritability, frequency and nocturiaBladder irritability, frequency and nocturia
 Causes:Causes:
 increased circulation in pelvis (E and Pincreased circulation in pelvis (E and P↑↑))
 enlargement of uterus.enlargement of uterus.
 Differential Diagnosis: urinary infectionurinary infection

12. 12
Diagnosis of Early PregnancyDiagnosis of Early Pregnancy
4.4. MastodyniaMastodynia
 breast tendeness from tingling to frankbreast tendeness from tingling to frank
painpain
 Causes:Causes:
 the development of mammary ducts (Ethe development of mammary ducts (E↑↑))
and alveolar system (Pand alveolar system (P↑↑))
 circulationcirculation↑→↑→ engorgement of the breastsengorgement of the breasts

13. 13
Diagnosis of Early PregnancyDiagnosis of Early Pregnancy
 SignsSigns
1 The changes of genital organs1 The changes of genital organs
 Vagina: bluish or purple discoloration (congestedVagina: bluish or purple discoloration (congested
pelvic vasculature). Increased vaginal discharge (Epelvic vasculature). Increased vaginal discharge (E
and Pand P↑↑))
 Cevix: softening and bluish discoloration.Cevix: softening and bluish discoloration.
 Enlargement of uterus (noticed at the 12Enlargement of uterus (noticed at the 12thth
week )week )

14. 14
Diagnosis of Early PregnancyDiagnosis of Early Pregnancy
 Hegar’s signHegar’s sign: Widening of the softened area of the: Widening of the softened area of the
isthmus, in compressibility on bimanual examination.isthmus, in compressibility on bimanual examination.

15. 15
Diagnosis of Early PregnancyDiagnosis of Early Pregnancy
2.2. Breast changesBreast changes
 EnlargementEnlargement
 the development of mammary ducts andthe development of mammary ducts and
alveolar systemalveolar system
 engorgement of breastsengorgement of breasts
 sebaceous glands( Montgomery'ssebaceous glands( Montgomery's
tubercles)tubercles)
 Linea Nigra :darkening of NipplesLinea Nigra :darkening of Nipples..

16. 16
Diagnosis of Early PregnancyDiagnosis of Early Pregnancy
 Assistant ExaminationAssistant Examination
1 Pregnancy test1 Pregnancy test the simplest and most common methodthe simplest and most common method
 Urine HCG test : + or –Urine HCG test : + or –
 Urine HCC test + about 95% of the possibility of pregnancyUrine HCC test + about 95% of the possibility of pregnancy
 bloodblood ββ-HCG:-HCG: a sensitive and specific test , early pregnancy testsa sensitive and specific test , early pregnancy tests
identification of human chorionic gonadotropin (identification of human chorionic gonadotropin (hCGhCG)as early as 7-9 days)as early as 7-9 days
after fertilizationafter fertilization
 bloodblood ββ-HCG + about 99% of the possibility of pregnancy-HCG + about 99% of the possibility of pregnancy

17. 17
Pregnancy testPregnancy test
Urine HCG testUrine HCG test

18. 18
Diagnosis of Early PregnancyDiagnosis of Early Pregnancy
2.2. UltrasonographyUltrasonography
 Enlargement of uterusEnlargement of uterus
 GestationalGestational sac
 Embryo or fetal pulseEmbryo or fetal pulse at 5-6 week
 Crown to rump length(CRL)Crown to rump length(CRL)
measured at 5 -12 weeks the most accurate gestationalmeasured at 5 -12 weeks the most accurate gestational
age.age.

19. 19
Genetic screen/prenatal screenGenetic screen/prenatal screen
nuchal translucency （ NT ）
Early pregnancy signs commonly used in genetic screening

20. 20
First Trimester Down syndrome screening

21. 21
Teratogenic fetal organs of the sensitive period mapTeratogenic fetal organs of the sensitive period map
For structural malformations,embryo is the most important, Continued development of functional is very important at fetus

22. 22
Diagnosis of Early PregnancyDiagnosis of Early Pregnancy
3. Basal body temperature3. Basal body temperature
((BBT)BBT)
A persistent elevation of BBT for longer than 18 daysA persistent elevation of BBT for longer than 18 days
may be presumptive evidence of pregnancy.may be presumptive evidence of pregnancy.

23. 23
Diagnosis of Early PregnancyDiagnosis of Early Pregnancy
4. Progesterone test4. Progesterone test
Progesterone given to amenorrhea.
 pregnant, no bleeding follow
 nonpregnant bleeding should
occur within 7-10 days of
progesterone
 adequate estrogen stimulation
of the endometrium.

24. 24
Diagnosis of Early PregnancyDiagnosis of Early Pregnancy
5. Cervical mucus5. Cervical mucus
The cervical mucus smearThe cervical mucus smear
a progestational effect—a progestational effect—
ellipsoidellipsoid →→ fern crystallization.fern crystallization.
cervical mucous
(1) type (Ⅰ ＋＋＋ ) ： typical fern crystallization
(2) type (Ⅱ ＋＋ ) ： fern crystallization
(3) type (Ⅲ ＋ ) ： atypical fern crystallization
(4) type (Ⅳ － ) ： ellipsoid

25. 25
Diagnosis of mid or late pregnancyDiagnosis of mid or late pregnancy
 HistoryHistory 、、 Symptoms andSymptoms and
signsign
 Early pregnancy courseEarly pregnancy course
 Abdomen gradually increasingAbdomen gradually increasing

26. 26
Diagnosis of mid or late pregnancyDiagnosis of mid or late pregnancy
 Symptoms and signSymptoms and sign
1.1. Enlargement of uterusEnlargement of uterus
 1212thth
week: 2 finger above the symphysisweek: 2 finger above the symphysis
 1616thth
week: midway between the symphysis and the umbilicus.week: midway between the symphysis and the umbilicus.
 2020thth
week: at the umbilicusweek: at the umbilicus
 2424thth
week: 2 finger above the umbilicus.week: 2 finger above the umbilicus.
 2828thth
week:3 finger above the umbilicus.week:3 finger above the umbilicus.
 3232thth
week: midway between the umbilicus andweek: midway between the umbilicus and xiphoid bone
 3636thth
week: 2 finger below theweek: 2 finger below the xiphoid bone
 4040thth
week: midway between the umbilicus andweek: midway between the umbilicus and xiphoid bone

27. 27
Diagnosis of mid or late pregnancyDiagnosis of mid or late pregnancy
2. Fetal movement (FM)2. Fetal movement (FM)
 The first perception: in the 18The first perception: in the 18thth
– 20– 20thth
weeksweeks multipara /primipara
 Diagnosis of pregnancy, the safety of fetusDiagnosis of pregnancy, the safety of fetus
 Count: 3 times per dayCount: 3 times per day
1 hour per time. sum1 hour per time. sum××4= FM/12 hours4= FM/12 hours
Normal:Normal: ≥≥ 4/ hour ,4/ hour ,≥≥ 30/12 hours30/12 hours

28. 28
Diagnosis of mid or late pregnancyDiagnosis of mid or late pregnancy
3. Fetal heart tones3. Fetal heart tones
 Heared: the 18th
– 20th
weeks by fetoscope /the 10th
weeks by
Doppler ultrasound
 Normal rate: 120-160 （ bpm ）） beats per minute
 Differentiation: umbilical souffle etcDifferentiation: umbilical souffle etc
4. Fetal body4. Fetal body
Palpated: outlines from maternal abdominal wall(the 20Palpated: outlines from maternal abdominal wall(the 20thth
week).week).

29. 29
Diagnosis of mid or late pregnancyDiagnosis of mid or late pregnancy
 Assistant ExaminationAssistant Examination
 UltrasonographyUltrasonography
 MeasureMeasure
 fetal growth parameterfetal growth parameter
 amniotic fluid volume
 placenta
 umbilicus cord

30. 30
Diagnosis of mid or late pregnancyDiagnosis of mid or late pregnancy
 Assistant ExaminationAssistant Examination
 UltrasonographyUltrasonography
 Exclusion fetal malformationsExclusion fetal malformations
NormalNormal
spinespine
NTDNTD
Spinal cleftanencephalus

31. 31
Diagnosis of mid or late pregnancyDiagnosis of mid or late pregnancy
 Assistant ExaminationAssistant Examination
 UltrasonographyUltrasonography
 Size ofSize of fetus:fetus:fetal biparietal diameter/ Fetal femur length/abdominalfetal biparietal diameter/ Fetal femur length/abdominal
circumferencecircumference
 Fetal well-being :Fetal well-being :measure biophysical characteristics.measure biophysical characteristics.
 Placenta maturityPlacenta maturity
 Amniotic fluid volume
 Umbilical Cord Blood
 number of fetusnumber of fetus

32. 32
Diagnosis of mid or late pregnancyDiagnosis of mid or late pregnancy
 Fetal electrocardiographyFetal electrocardiography
（（ FECGFECG ））
1212thth
weekweek

33. 33
Fetal AttitudeFetal Attitude
The posture of fetus in theThe posture of fetus in the uterus
 Fetal lieFetal lie
the relationship of the long axis of the fetus to the long axis ofthe relationship of the long axis of the fetus to the long axis of
the motherthe mother
 Longitudinal lieLongitudinal lie
long axis of fetus parallel with motherlong axis of fetus parallel with mother
 Transverse lieTransverse lie
long axis of the fetus vertical motherlong axis of the fetus vertical mother

34. 34
Fetal AttitudeFetal Attitude
 Fetal presentation:Fetal presentation: first part of the fetus into pelvicfirst part of the fetus into pelvic
 head presentationhead presentation
 Occiput presentation (95%)Occiput presentation (95%)
 anterior fontanelle presentationanterior fontanelle presentation
 brow presentationbrow presentation
 face presentationface presentation

35. 35
Fetal AttitudeFetal Attitude
 Fetal presentationFetal presentation
 Breech presentationBreech presentation
 Complete breech presentationComplete breech presentation
 Frank breech presentationFrank breech presentation
 Incomplete breech presentation: footling presentationIncomplete breech presentation: footling presentation

36. 36
Fetal AttitudeFetal Attitude
 Fetal positionFetal position
relationship ofrelationship of the point of directionthe point of direction to oneto one
of the 4 quadrants of the pelvisof the 4 quadrants of the pelvis
 Occiput presentation: the occiput, O.Occiput presentation: the occiput, O.
LOA,LOT,LOPLOA,LOT,LOP
 Face presentation:Face presentation: mandibular,M.,M.
LMA,LMT,LMPLMA,LMT,LMP
 Breech presentation:sacrum,S.Breech presentation:sacrum,S.
LSA,LST,LSPLSA,LST,LSP

37. 37
symptoms and signs of pregnancy diagnosissymptoms and signs of pregnancy diagnosis

38. 38
Summary
 Whole pregnancy process by stages
 Diagnosis of Early PregnancyDiagnosis of Early Pregnancy
 Diagnosis of mid or late pregnancyDiagnosis of mid or late pregnancy
 Fetal AttitudeFetal Attitude

39. 39
The Whole Period of Pregnancy DividedThe Whole Period of Pregnancy Divided
Into Three Stages:Into Three Stages:
from the first day of the last menstrual period (LMP) with an average 280 days, 40 weeks
 The first trimester (early pregnancy): 1-12wThe first trimester (early pregnancy): 1-12w
 The second trimester (middle pregnancy): 13-27 wThe second trimester (middle pregnancy): 13-27 w
 The third trimester (late pregnancy): 28-40wThe third trimester (late pregnancy): 28-40w

40. 40
Diagnosis of Early PregnancyDiagnosis of Early Pregnancy
 History and symptoms:History and symptoms:
 Amenorrhea
 Morning sickness
 Urinary symptoms
 Mastodynia
 SignsSigns
 The changes of genital organs
 Breast changes
Assistant ExaminationAssistant Examination
Pregnancy testPregnancy test
UltrasonographyUltrasonography
Basal body temperatureBasal body temperature
Progesterone testProgesterone test
Cervical mucusCervical mucus

41. 41
Diagnosis of mid or late pregnancyDiagnosis of mid or late pregnancy
 History and symptoms:History and symptoms:
 Early pregnancy course
 Abdomen gradually increasing
 Symptoms and SignsSymptoms and Signs
 Enlargement of uterus
 Fetal movement
 Fetal heart tones
 Fetal body
Assistant ExaminationAssistant Examination
Ultrasonography
Fetal electrocardiography

42. 42
Fetal AttitudeFetal Attitude
Fetal lieFetal lie
Fetal presentationFetal presentation
 Fetal positionFetal position

43. 43
• Female, 25 years old, married, normalFemale, 25 years old, married, normal
menstrual cycle, not contraception,menstrual cycle, not contraception,
• the first day of the last menstrual periodthe first day of the last menstrual period
(LMP) is 2011/01/20(LMP) is 2011/01/20
• Now she come to ……Now she come to ……
How consider about ?How consider about ? How do you do first?How do you do first?
If you are a doctor inIf you are a doctor in clinic…………

44. Thanks for Your AttentionThanks for Your Attention
第七版《妇产科学》配套课件第七版《妇产科学》配套课件
主 ： 杰 幸 林仲秋 苟文 狄 文编 乐 谢 丽主 ： 杰 幸 林仲秋 苟文 狄 文编 乐 谢 丽
4444
THANKS FOR YOUR ATTENTION!THANKS FOR YOUR ATTENTION!