This document discusses the diagnosis of pregnancy through history, physical examination, laboratory tests, and ultrasound examination. It details the signs and symptoms assessed in history and physical exam. It then describes the use of beta-hCG laboratory tests to detect pregnancy as early as 3-4 weeks through various immunoassay methods. It outlines when ultrasound can visualize gestational sac, yolk sac, fetal pole, and fetal heart to confirm intrauterine pregnancy.

1. DIAGNOSIS OF PREGNANCY
DR ALKA MUKHERJEE
DR APURVA MUKHERJEE
NAGPUR M.S. INDIA

2. DR ALKA MUKHERJEE
MBBS DGO FICOG FICMCH PGDCR PGDMLS MA(PSY)
Director & Consultant At Mukherjee Multispecialty Hospital
MMC ACCREDITATED SPEAKER
MMC OBSERVER MMC MAO – 01017 / 2016
Present Position
 Director of Mukherjee Multispecialty Hospital
 Hon.Secretary INTERNATIONAL COUNCIL FOR HUMAN RIGHTS
 Hon.Secretary NARCHI NAGPUR CHAPTER (2018-2020)
 Hon.Secretary AMWN (2018-2021)
 Hon.Secretary ISOPARB (2019-2021)
 Life member, IMA, NOGS, NARCHI, AMWN & Menopause
Society, India, Indian medico-legal & ethics association(IMLEA),
ISOPRB, HUMAN RIGHTS
 Founder Member of South Rapid Action Group, Nagpur.
 On Board of Super Specialty, GMC, IGGMC, AIIMS Nagpur,
NKPSIMS, ESIS and Treasury, Nagpur for “ WOMEN SEXUAL
HARASSMENT COMMITTEE.”
mukherjeehospital@yahoo.com
www.mukherjeehospital.com
https://www.facebook.com/
Mukherjee Multispeciality
https://www.instagram.com/
Achievement
 Winner of NOGS GOLD MEDAL – 2017-18
 Winner of BEST COUPLE AWARD in Social
Work - 2014
 APPRECIATION Award IMA - MS
 Past Position
 Organizing joint secretary ENDO-GYN
2019
 Vice President IMA Nagpur (2017-2018)
Vice President of NOGS(2016-2017)
Organizing joint secretary ENDO-GYN
Organizing secretary AMWICON – 2019

3. Introduction
Pregnancy can be diagnosed by a combination of history/physical
examination, laboratory tests, or ultrasound examination.
History:
● Amenorrhoea
● Menstrual history
● Date of onset of last menstrual bleeding (LMP)
● Duration of menstrual bleeding
● Frequency/irregularity of menstrual bleeding
● Use of contraception
● Atypical last menstrual bleeding
● Use of in vitro fertilization (IVF) techniques.

4. Physical examination
● Breast changes (darkening of nipples)
● Blue discoloration of the cervix and vagina
(Chadwick’s sign)
● Softening of the cervix (Goodell’s sign)
● Enlarged cervix and softening—ability to approximate
fi ngers in the vagina from behind and in front on
the abdomen across the isthmus (Hegar’s sign)
● Softening of the uterus (Ladin’s sign)
● Enlarged uterus on bimanual examination.

5. Laboratory tests
Beta-human chorionic gonadotrophin (beta-hCG):
● hCG is a glycoprotein composed of alpha and beta subunits
● The alpha subunit is similar to the alpha subunit of FSH, LH, and
thyrotropin
● hCG is present in the maternal circulation as either an intact dimer,
alpha or beta subunit, or beta core
fragment
● The beta core fragment emerges as the predominant form in the fi
fth week after conception
● The beta subunit core fragment is primarily detected by pregnancy
tests in urine samples
● Most current urinary pregnancy tests have sensitivity to
approximately 25 mIU/mL.

6. There are four types of immunoassays.
● Radioimmunoassay
● Sensitivity—5 mIU/mL
● Gestational age when fi rst positive—3–4 weeks
● Immunoradiometric assay
● Sensitivity—150 mIU/mL
● Gestational age when fi rst positive—4 weeks
Enzyme-linked immunosorbent assay
● Sensitivity—25 mIU/mL
● Gestational age when fi rst positive—3.5 weeks
● Fluoroimmunoassay
● Sensitivity—1 mIU/mL
● Gestational age when fi rst positive—3.5 weeks.

7. Serial hCG monitoring:
● At 4 weeks’ gestation, hCG doubling times are
approximately 2.2 days
● By 9 weeks’ gestation, hCG doubling times are
approximately 3.5 days
● hCG levels peak at 10–12 weeks’ gestation
● Failure to achieve the projected rate of rise of
hCG may suggest an ectopic pregnancy, non-
viable
pregnancy, or spontaneous abortion.

8. Ultrasonography
● Transvaginal ultrasonography (TVUS) with frequency of 5–8 MHz
● Transabdominal ultrasonography (TAUS) with frequency of 3–5
MHz
● TVUS detect signs of intrauterine pregnancy approximately 1 week
earlier than TAUS
● TVUS is the most accurate means of confi rming intrauterine
pregnancy and gestational age during the early fi rst trimester
● If hCG levels are >1000–1500 mIU/mL, pregnancy structures should
be identifi able inside the uterus
● If no intrauterine pregnancy structures on TVUS and hCG >1000–
1500 mIU/mL, ectopic pregnancy is a possible diagnosis.

9. Structures of pregnancy are identified by TVUS in a
chronologic order:
● Gestational sac (GS) by 4–5 weeks of gestation
● Double-decidual sign (GS surrounded by the
thickened deciduas) by 5.5–6 weeks
● Yolk sac (YS) by 4–5 weeks—diagnosis of
intrauterine pregnancy
● Fetal pole by 5–6 weeks
● Fetal heart by 5–6 weeks.