This document discusses the diagnosis and assessment of pregnancy. It outlines common symptoms of pregnancy like missed periods, morning sickness, and breast changes. Physical signs identified on examination include darkened nipples, skin pigmentation, and palpation of the uterus. Tests and calculations, like using the last menstrual period, are described to confirm pregnancy and estimate gestational age. Complications in each trimester are briefly mentioned. Important terms related to the stages and progression of pregnancy are also defined.

1. Diagnosis of
pregnancy

2. Objectives
 At the end of the session will be able to:
 Diagnose pregnancy from symptoms and signs.
 Calculate the gestational age.
 Define important terms related to pregnancy.

3. Diagnosis of pregnancy
 Symptoms
 Signs
 Tests
 False positives

6. Symptoms of pregnancy
 Cessation of menstruation
 Subjective symptoms
 Morning sickness
 Irritation of breasts
 Nausea and vomiting
 Fatigue
 Increase in frequency of micturation

7. Signs of pregnancy
 Breast;
Fullness, areola pigmentation, Montgomery's
tubercles( hypertrophied sebaceous glands), reliable
sign in Primigravida.
 Face;
Brown pigmentation, mask usually patchy (Cholasma)
 Abdomen;
 Linea nigra, brown or black pigmentation-stretching of
collagen and elastin.
 Striae gravidarum, stretch marks, red or purple during
pregnancy, turns on to white after pregnancy. Situated
in the lower abdomen, breasts, thighs, buttock.
 Palpation, uterus palpable at 12 weeks of gestation

9. Vaginal examination
 Vaginal mucosa;
Jacquermin’s sign
Dark Bluish colouration Chadwick’s sign
 Hegar’s sign of pregnancy
Bimanual palpation of soft uterine isthmus
between the cervix and the body.
Cystic sensation of uterus by 8 weeks
 Leukorrhea, increase in vaginal discharge

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11. Important Definitions
 Gravid
 Parous
 Primigravida Nullipara or nulliparous
 Multigravida Multiparous
 Grand multiparaous

12. Calculation of the gestational age
 Last menstrual period (LMP), regular, irregular,
on the combined oral contraceptive pills,
number of spontaneous cycles, bleeding in early
pregnancy.
 Expected date of delivery/ confinement (EDD,
EDC),
Estimated by regularity of periods, no immediate
past oral pills, no bleeding in early pregnancy.
Naegle’s rule, add one year
subtract 3 months
add 7 days

13. If the cycle is irregular, or was on the combined pills
How to estimate EDD; in the olden days and modern
age????
Is the period of amenorrhae and the
period of gestation the same????

14. Terms related to pregnancy
 Term, It is a period of time . It is
not the same as EDD
 Preterm, before 37 completed
weeks of gestation
 Posterm, after 42 completed weeks
of getation
 Preterm and premature
 Posterm and post maturity

15. Period of gestation
(Trimesters)
 Pregnancy is divided into three trimesters
 First up to 14 weeks
 Second up to 28 weeks of gestation
 Third trimester up to 42 weeks of gestation.
 Each trimester has its own
problems/complications/events

16. First Trimester
 Confirm the pregnancy
Symptoms and signs
Pregnancy tests
Antenatal Booking, type of care
Perinatal diagnosis.
Be alert, high hCG and empty uterus on
USS , with or without vaginal bleeding,
and with or without abdominal pain!!

17. Second trimester
 Perinatal diagnosis, USS
 Fetal quickening
 Findings at ANC

18. Third trimester
 Findings at ANC
 Fetal assessment if indicated
 Chronological hospital admissions if any

19. Important terms
 Braxton Hicks contractions;
Occurs from first trimester
painless
spontaneous
irregular
do not lead to labour
Lower uterine segment
The thin expanded lower portion of the uterus( the isthmus), forms in
the last trimester of pregnancy, after 32 weeks of gestation. It
provides the usual method of approach to deliver the baby during
Caesarean section (CS).
Lightening
Usually occurs after 36 weeks, more in primigravida.
Mother notices that it is easier to breath.

20. More important terms
 Presenting part
The part of the fetus felt abdominally,
vaginally
 The four Leopoldt’s grip, with two
hands
1. Fundal grip
2. Lateral grip
3. deep pelvic grip
4. Pawlik’s grip, Suprapubic palpation
with one hand to identify the
presenting part
 To identify the station