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DIAGNOSIS OF
PREGNANCY
PRESENTED BY :
MS. VRUTI PATEL,
F.Y.M.SC. NURSING,
SCN
INTRODUCTION
Presumptive signs
Probable signs
Positive signs
DIAGNOSIS THE PREGNANCY
In first trimester
In second trimester
In third trimester
FIRST TRIMESTER (FIRST 12 WEEKS)
Subjective Sentence
 Amenorrhoea – Abrupt cessation of
menstruation at 4th week
 Morning sickness (Nausea and vomiting) from
4th – 14th week
 Frequency of micturition (Bladder irritability
 Breast discomfort
 Fatigue
Objective sign
• Breast changes - valuable only in primigravidae
• Per abdomen
• Pelvic changes
• Jacquemier’s or chadwick’s sign
• Vaginal sign
• Cervical signs - as early as 6th week (Goodell’s
sign)
• Uterine signs : (a) Size, shape and consistency
(b) Hegar’s sign
(c) Palmer’s sign
IMMUNOLOGICAL TESTS FOR
DIAGNOSIS OF PREGNANCY
• Principle : Pregnancy tests depend on
detection of the antigen (hCG) present in
the maternal urine or serum with antibody
either polyclonal or monoclonal available
commercially.
(A) Immuno assays without radioisotopes
• Agglutination inhibition tests – Using latex
(L.A.I.)
• Principle of agglutination inhibition tests
• Direct agglutination test (hCG direct test)
• Enzyme-linked immunosorbent assay (ELISA
• Fluoroimmuno assay (FIA)
(B) Immuno assay with radiosotopes
• Radioimmunossay (RIA) - used for determining
the doubling time of hCG (ectopic pregnancy
monitoring)
• Immuno-radiometric assay (IRMA) - detect
hCG as low as 0.05 mIU/ml
Selection of time
Collection of urine
Other uses of pregnancy tests
Ultrasonography
SECOND TRIMESTER (13-28 WEEKS)
Symptoms :
• subjective symptoms –such as nausea,
vomiting and frequency of micturition usually
subside
• Quickening (feeling of life)
• Progressive enlargement of the lower
abdomen
General Examination
o Chloasma : Pigmentation over the forehead and
cheek
o Breast changes - enlarged with prominent veins,
Secondary areola, Montgomery’s tubercles are
prominent and extended, Colostrum
o Abdominal examination
• Inspection
• Palpation
• Auscultation - Uterine souffle - soft blowing and
systolic murmur heard low down at the sides of the
uterus, best on the left side; Funic of fetal soufflé is due
to rush of blood through the umbilical arteries
o Vaginal Examination
• The bluish discolouration
• Internal ballottement
o Investigations
• Sonography
• Fetal organ anatomy
• Magnetic Resonance Imaging (MRI
LAST TRIMESTER (29-40 WEEKS)
Symptoms
(1) Amenorrhoea persists
(2) Enlargement of the abdomen is progressive
(3) Lightening – At about 38th week
(4) Frequency of micturition
(5) Fetal movements
 SIGNS
• Cutaneous changes
more prominent with
increased pigmentation
and striae
• Uterine shape
changed from cylindrical
to spherical beyond 36th
week.
• Fundal height • Symphysis fundal
height (SFH) The
upper border of the
fundus is located by the
ulnar border of the left
hand and this point is
marked
• Braxton-Hicks
contractions are more
evident.
• Fetal movements are
easily felt
• Palpation of the fetal
parts
• FHS
• Sonography
DIFFERENTIAL DIAGNOSIS
• Uterine Fibroid,
• Cystic Ovarian Tumour,
• Encysted Tubercular Peritonitis,
Haematomata
• Even Distended Urinary Bladder, etc.
Diagnosis of pregnancy
Diagnosis of pregnancy

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Diagnosis of pregnancy

  • 1. DIAGNOSIS OF PREGNANCY PRESENTED BY : MS. VRUTI PATEL, F.Y.M.SC. NURSING, SCN
  • 3. DIAGNOSIS THE PREGNANCY In first trimester In second trimester In third trimester
  • 4. FIRST TRIMESTER (FIRST 12 WEEKS) Subjective Sentence  Amenorrhoea – Abrupt cessation of menstruation at 4th week  Morning sickness (Nausea and vomiting) from 4th – 14th week  Frequency of micturition (Bladder irritability  Breast discomfort  Fatigue
  • 5. Objective sign • Breast changes - valuable only in primigravidae • Per abdomen • Pelvic changes • Jacquemier’s or chadwick’s sign • Vaginal sign • Cervical signs - as early as 6th week (Goodell’s sign) • Uterine signs : (a) Size, shape and consistency (b) Hegar’s sign (c) Palmer’s sign
  • 6. IMMUNOLOGICAL TESTS FOR DIAGNOSIS OF PREGNANCY • Principle : Pregnancy tests depend on detection of the antigen (hCG) present in the maternal urine or serum with antibody either polyclonal or monoclonal available commercially.
  • 7. (A) Immuno assays without radioisotopes • Agglutination inhibition tests – Using latex (L.A.I.) • Principle of agglutination inhibition tests • Direct agglutination test (hCG direct test) • Enzyme-linked immunosorbent assay (ELISA • Fluoroimmuno assay (FIA)
  • 8. (B) Immuno assay with radiosotopes • Radioimmunossay (RIA) - used for determining the doubling time of hCG (ectopic pregnancy monitoring) • Immuno-radiometric assay (IRMA) - detect hCG as low as 0.05 mIU/ml Selection of time Collection of urine Other uses of pregnancy tests Ultrasonography
  • 9. SECOND TRIMESTER (13-28 WEEKS) Symptoms : • subjective symptoms –such as nausea, vomiting and frequency of micturition usually subside • Quickening (feeling of life) • Progressive enlargement of the lower abdomen
  • 10. General Examination o Chloasma : Pigmentation over the forehead and cheek o Breast changes - enlarged with prominent veins, Secondary areola, Montgomery’s tubercles are prominent and extended, Colostrum
  • 11. o Abdominal examination • Inspection • Palpation • Auscultation - Uterine souffle - soft blowing and systolic murmur heard low down at the sides of the uterus, best on the left side; Funic of fetal soufflé is due to rush of blood through the umbilical arteries
  • 12. o Vaginal Examination • The bluish discolouration • Internal ballottement
  • 13. o Investigations • Sonography • Fetal organ anatomy • Magnetic Resonance Imaging (MRI
  • 14. LAST TRIMESTER (29-40 WEEKS) Symptoms (1) Amenorrhoea persists (2) Enlargement of the abdomen is progressive (3) Lightening – At about 38th week (4) Frequency of micturition (5) Fetal movements
  • 15.  SIGNS • Cutaneous changes more prominent with increased pigmentation and striae • Uterine shape changed from cylindrical to spherical beyond 36th week.
  • 16. • Fundal height • Symphysis fundal height (SFH) The upper border of the fundus is located by the ulnar border of the left hand and this point is marked
  • 17. • Braxton-Hicks contractions are more evident. • Fetal movements are easily felt
  • 18. • Palpation of the fetal parts • FHS
  • 20. DIFFERENTIAL DIAGNOSIS • Uterine Fibroid, • Cystic Ovarian Tumour, • Encysted Tubercular Peritonitis, Haematomata • Even Distended Urinary Bladder, etc.