This study analyzed prenatal diagnosis and termination of pregnancy data for birth defects in Hunan, China between 2015-2018. Over half of birth defects were diagnosed prenatally, with the average gestational age at diagnosis being 25 weeks. Rural areas and older mothers had higher rates of prenatal diagnosis and termination following diagnosis compared to urban areas and younger mothers. Conditions with the highest rates of prenatal diagnosis and termination included conjoined twins, chromosomal abnormalities, and central nervous system defects.

1. DIAGNOSIS OF PREGNANCY

2. INTRODUCTION
The diagnosis of pregnancy traditionally has been
made from history and physical examination.
Important aspects of the menstrual history must be
obtained. The woman should describe her usual
menstrual pattern, including date of onset of last
menses, duration, flow, and frequency

3. TERMINOLOGY
Amniotic sac
Braxton Hicks Contractions
Conception
Fetus
Gestation
Placenta
Trimesters
Ultrasound

4. MENSTRUAL AGE

5.  Also known gestational age .
 From the first day of the last menstrual period…
 9 months and 7 days
 280 days
 40 weeks

6. TRIMESTER

8. DIAGNOSIS OF 1ST
TRIMESTER

9. SUBJECTIVE SIGN

10. OBJECTIVE SIGN

11. IMMUNIOLOGICAL TEST

12. HCG( HUMANCHORIONIC
GONODOTROPIN)

13. • Detection of HCG in maternal serum and urine is evident only
8- 10 days after conception
• HCG is detectable in the serum of approximately 5% of patients
8 days after conception and in more than 98% of patients by day
11
• Diagnostic levels in Urine seen only about 23-24 days after
conception. Levels peak at 10-12 weeks' gestation and then
plateau before falling

14. BLOOD TEST
FOR HCG

15. 4 main HCG assays are used
(1) radioimmunoassay
(2) immunoradiometric assay
(3) enzyme-linked immunosorbent assay (ELISA)
(4) fluoro immunoassay.

16. ULTRASOUND

17. • Intra decidual gestational sac is identified as early as 29
– 35 days of gestation
• Gestational sac & yolk sac -5 menstrual weeks
• Fetal pole and cardiac activity – 6 weeks
• Embryonic movements -7 weeks
• Doppler effect of USG can pick heart rate reliably by
10th week.

18. DIAGNOSIS IN
THE SECOND
TRIMESTER (
13-28 WEEKS)

20. ABDOMINAL EXAMINATION
 INSPECTION: – Linea nigra extending from symphysis
pubis to ensiform cartilage  20th week…
 STRIAE ( both pink and white) visible in the lower
abdomen more towards the flanks
 PALPATION: –
Fundal height – increased with progressive enlargement of
the uterus.

21. Auscultation
• Auscultation of FHS as early as 20-24 weeks by Pinard
stethoscope
• Auscultation of funic/fetal souffle due to rush of blood
through the umbilical artery
• Auscultation of uterine souffle (soft blowing and systolic
murmur heard low own at the sides of the uterus)
synchronous with the maternal pulse

22. INVESTIGATIONS
• SONOGRAPHY: – Routine sonography at 18 – 20
weeks permits a detailed survey of fetal anatomy,
placental localisation and the integrity of the cervical
canal.
• RADIOLOGIC: – 16TH WEEK – FETAL SKELETAL SHADOW.

23. DIAGNOSIS
IN THE THIRD
TRIMESTER
(29 -
40WEEKS)

24. • AMENORRHOEA PERSISTS – Enlargement of the abdomen leading to
discomfort to the patient (palpitation or dyspnoea following
exertion)
• LIGHTENING: 38th week sense of relief of the pressure
symptoms due to engagement of the presenting part.
• Frequency of micturition reappears – Fetal movements are more
pronounced.
• SIGNS: – Cutaneous changes are more prominent with increased
pigmentation and striae. Uterine shape – from cylindrical to
spherical beyond 36th week

25. •FUNDAL HEIGHT (distance between the
umbilicus and ensiform cartilage)
• Junction of the upper and middle third at 32 weeks.
• Level of ensiform cartilage at 36th week
• Comes down to 32 week level at 40th week
because of the engagement of the presenting part.

26. SYMPHYSIS FUNDAL
HEIGHT
– Upper border of the fundus located by
ulnar border of the left hand and point is
marked.
– Distance between the upper border of
the symphysis pubis up to the point
marked is measured in centimetre

28. SIGNS OF PREVIOUS CHILDBIRTH
• Breast become more flabby
•Abdominal wall is more lax and loose. There
may be presence of silvery white striae and
linea alba.
•Uterine wall is less rigid and the contour of
the uterus is broad and round, rather than
ovoid.

29. • Perineum is lax and evidence of old scarring
from previous perineal laceration or
episiotomy may be found
•Vagina is more roomy.
•Cervix: Nulliparous cervix is conical with a
round external os. In parous women, it
becomes cylindrical

30. ESTIMATION OF GESTATIONAL AGE AND PREDICTION OF
EXPECTED DATE OF DELIVERY(EDD)
Gestational age is about 280 days calculated
from the first day of the last normal menstrual
period (LMP). Accurate LMP is the most
reliable parameter for estimation of gestational
age.

31. PATIENT'S STATEMENT
• Date of fruitful coitus
• Naegele's formula
• Date of quickening

32. INVESTIGATIONS
•Sonography-The following parameters are of use.
• First trimester- CRL is most accurate (variation±
5 days).
To add 30 weeks since the documentation of fetal
heart tones by Doppler USG.

33. •Second trimester by BPD, HC, AC and FL
measurement. Most accurate when done between 12
and 20 weeks (variation ± 8 days).
To add 20 weeks since the measurement of fetal
parameters for anomaly scan (18-20 weeks).
Third trimester-less reliable, variation ± 16 days.

34. • SUMMARY:-
Today we discuss about diagnosis of pregnancy according their trimester. We also
discuss about differential diagnosis, previous birth sign, expected date of delivery.
• CONCLUSION
The diagnosis of pregnancy can be made by several methods. Normocyclic
women who present with amenorrhea and typical history and physical exam
findings have the classic presentation and can be diagnosed with a viable
intrauterine pregnancy if they progress appropriately.

35. RESEARCH ABSTRACT
• Objective: The aim of this study was to analyse the characteristics of
the prenatal diagnosis (PD) of birth defects (BDs) and termination of
pregnancy (TOP) for fetal anomalies and to suggest perinatal
management.
• Methods: BD surveillance data were collected from 52 registered
hospitals in Hunan between 2015 and 2018. The PD and TOP rates of
BDs were calculated to examine the associations between infant sex,
maternal age, and region.

36. Results:
From 2015 to 2018, a total of 18 931 fetuses with BDs
were identified, of which 10 299 fetuses (54.4%) were
diagnosed prenatally and 9343 pregnancies (90.7% among
PDs and 49.3% among BDs) were terminated. The mean
gestational age at diagnosis for fetuses with BDs was 25.1 ±
5.9 weeks and showed a downward trend over the study
period. The average PD rate of the BDs was higher in rural
areas than in urban areas (58.1% vs 50.3%), higher for
female than male fetuses (57.25% vs 48.92%), and higher
for mothers older than age 35 than for those younger
(58.62% vs 53.69%).

37. The average TOP rate of fetuses with BDs in rural areas
was higher than that in urban areas (91.99% vs 89.12%)
and decreased with increasing maternal age
( x2trendxtrend2 = 7.926, P = .005). The five BDs with the
highest PD rates were conjoined twins (100%),
anencephaly (97.87%), congenital hydrocephalus
(97.66%), chromosomal malformation (96.07%), and
encephalocele (95.54%). The five BDs with the highest
TOP rates among the PDs were conjoined twins (100%),
exstrophy of the urinary bladder (100%), chromosomal
malformation (98.09%), encephalocele (98%), and
anencephaly (97.28%).

38. •Conclusions: More than half of BDs were diagnosed
prenatally, with the majority diagnosed at less than 28
gestational weeks. The TOP rates following PD in Hunan
Province were high, especially for rural and younger
mothers. The findings suggest a need for high-quality,
targeted counselling following PD.
•Conducted On: 10 June 2020