Physiological changes during pregnancy Diagnosis of Pregnancy Garbha Nidana - Garbhini Lakshana

1. PHYSIOLOGICAL CHANGES
& DIAGNOSIS OF
PREGNANCY
DR. JASMINE GUJARATHI
MS (Ayu.)
Prasuti tantra and Stri roga
G J Patel Institute of Ayurveda Studies and
Research
New Vallabh Vidyanagar, Anand, Gujarat

2. https://www.youtube.com/watch?v=L
qryKSrsLzo
Pregnancy places increased demands on the
expectant mother's body. Significant changes
occur in her body that are necessary to support
and nourish the fetus. These changes also
prepare her body for childbirth and lactation
(breastfeeding).

3. Genital organs
1. Uterus
increase from 7.5 x 5 x 2.5 cm in non pregnant states to 35 x 25 x
20 cm at term i.e. the volume increase 1000 time
1) weight: 50g-1000g
2) Size reaches 7.5 cm to 36 cm
3) Hypertrophy and hyperplasia of muscle cells
4) Endometrium→decidua: basal decidua, capsular decidua,
true decidua
5) Contraction: Braxton Hicks
6) Isthmus uteri: 1cm→ 7-10cm
7) Shape - pyriform in the non pregnant state , becomes globular at
8th week – 12th week
Oval – 28th week
Spherical – 36th week

5. Cervix
 It becomes hypertrophied , soft and bluish in colour due
to oedema and increased vascularity
Soon after conception , a thick cervical secretion obstructs
the cervical canal forming a mucous plug .
The endocervical epithelium proliferates and or everted
forming cervical ectopy (erosion)

6. Other changes
 The vagina becomes soft , warm , moist with increased secretion
and bluish in colour (Chadwick's sign) due to increased
vascularity
 pH of vagina becomes more acidic because of increased
estrogen
Estrogen – glycogen – lactic acid
Vagina is more warm and moist because of increased circulation
 Both ovaries are enlarged due to increased vascularity and
oedema particularly the ovary which contains the corpus luteum
 Corpus luteum continues to grow till 7 - 8 weeks , then it stops
growing, It becomes inactive and starts degeneration at 12
weeks

7. HAEMOTOLOGY CHANGES
1. Blood volume – 30 – 40%
2. Plasma volume – 40 – 50%
3. RBC – 20-30%
4. Hb – 18-20%
Fall in haemoglobin concentration
Haemodilution
Advantages – Decreased blood
viscosity – optimum gaseous
exchange
Protection against blood loss

8. Gastrointestinal system
1) Gastric emptying time is prolonged→ nausea.
2) The motility of large bowel is diminished →
constipation
3) Liver function: unchanged

9. CVS
 « Uterus 400 ml/min extra
 • Kidneys 300 ml/min extra
 » Skin 500 ml/min extra
 « Elsewhere 300 ml/min extra.
 Cardiac output increases to 30 %

10. Chloasma gravidarum
pregnancy mask
Spider Naevi
CUTANEOUS CHANGES

11. Palmar erythema

12. Linea nigra

13. Striae Gravidarum
It may be due to mechanical
stretching or increased
glucocorticoids which results in
rupture of the elastic fibres in the
dermis and exposure of the vascular
subcutaneous tissues

14. Striae gravidarum

15. Breast changes
 Increase in size throughout pregnancy
 Total weight 400 gms at term
 Increased vascularity
 Duct alveolar proliferation and deposition of
fat
 Clear sticky fluid can be squeezed from
second month
 Secretion becomes yellow (colostrum) from
16th week

17. Fundal height

18. Weight gain
 Total 11 kg (1 +5+ 5)
Maternal reproductive weight gain
 Breasts – 400 gm
 Fetus – 3.5 Kg
 Placenta – 500 gm
 Amniotic fluid – 800 gm
 Uterus – 900 gm
Maternal body weight gain
 Fat – 3 kg
 Blood volume – 1.1 kg
 Water storage – 1.1 Kg

19. Diagnosis of
Pregnancy

20. Signs and Symptoms of pregnancy
Presumptive signs - Amenorrhoea, nausea, vomiting,
fatigue, frequent micturition, breast changes,
cutaneous changes (chloasma, linea nigra, striae,
quickening)
Probable signs – Hegar’s sign, Osiander’s sign,
Jacquimer’s sign, Chadwick’s sign, Palmer’s sign,
Goodell’s sign, Braxton hick’s contractions, internal and
external ballotment, Pregnancy tests
Positive signs – Fetal visualization through sonography,
Fetal heart sound, Visible fetal movements, palpation of
fetal parts (Lie, Position, Presentation, Attitude)

21. First trimester - Upto 12 weeks
1. Subjective symptoms
Amenorrhoea, Emesis gravidarum, Frequent micturition, breast discomfort, fatigue
2. Objective Signs
Breast changes – enlargement (6-8 weeks) pigmentation, Montgomery’s tubercle,
colostrum (12th week)
Jaquimer’s / Chadwick’ sign – Dusky hue or bluish discolouration of anterior vaginal
wall at 8th week due to vascular congestion
Osiander’s sign – Increased pulsation felt through fornices by 8th week
Goodell’s sign – Softening of cervix by 6th week
Hegar’s sign – between 6th to 10th week – two fingers in anterior fornix meet the
fingers of other hand suprapubically
Palmar’s sign – regular and rhythmic contraction of uterus for about 30 sec by 6 to 8
weeks

23. Hegar’s sign

25. Uterus size
Hens egg – 6th week
Cricket ball – 8th week
Fetal head – 12th week
Globular shape – 12th week
Acute anteverted – 6th to 8th week

26. Diagnosis of Early Pregnancy
 Laboratory tests
1. Pregnancy test
1) Urine HCG test (one step): + or –
2) β-HCG: >25mIU/L
(doubles every 36-8 hours )

27. 2. Ultrasonography
1) Enlargement of uterus
2) Gestational sac 5th week (ring)
2. TVS
1) Fetal pole – 6th week
2) Fetal movements – 7th week

32. Fetal Heart Sound
 Can be heard by doppler by 10 weeks
 140-160 initially

35. C. Supplementary examination
Pregnancy test
The laboratory test for pregnancy
are based on the identification of
human chorionic gonadotropin
(hCG), which can be detected as
early as 7-9 days after fertilization
by high sensitive technique. The
samples may be blood or urine.

36. Diagnosis of Early Pregnancy
3. Other tests
1) Progesterone test
2) Cervical mucus examination
3) Basal body temperature (BBT)

37. cervical mucus
The cervical mucus smear of
pregnant women shows a
progestational effect—that is
ellipsoid instead of fern
crystallization.

38. cervical mucous
(1) typeⅠ (＋＋＋) ： typical fern crystallization (2) typeⅡ (＋＋) ： fern
crystallization (3) type Ⅲ(＋) ：atypical fern crystallization
(4) type Ⅳ (－) ： ellipsoid

39. Basal body temperature (BBT)
A persistent elevation of BBT
for longer than 18 days may
be presumptive evidence of
pregnancy.

40. Progesterone test
Progesterone is given to a women
with amenorrhea. If she is
pregnant, no bleeding will follow,
otherwise, bleeding should occur
within 7-10 days of progesterone
administration. This is reliable in the
nonpregnant patient only if there is
adequate estrogen stimulation of
the endometrium.

41. Picture of normal fetus
a．Pregnancy of 8w；b．Pregnancy of 18w
BL-bladder；UT-uterus；GS-gestational sac

42. Second trimester (13th to 28th week)
Subjective symptoms
1. Amenorrhoea continues
2. Nausea, vomiting, frequent micturition, subsides
3. Quickening – Perception of active fetal movements by mother
Primigravida – 18th to 20th week
Multi gravida – 16th to 18th week
Useful for calculation of EDD
+ 22 weeks in primigravida
+ 24 weeks in multigravida

43. Objective signs
 1. Chloasma gravidarum - 24th week
 2. Breast changes – secondary areola – 20th week.
Montgomery’s tubercle are prominent
 3. Linea nigra – extended from symphysis pubis to
xiphisternum
 4. Striae – Visible in lower abdomen, flanks, breast, thighs
 5. Braxton hicks contractions – irregular, infrequent
spasmodic painless contractions without any dilatation of
cervix
 6. Increase in fundal height

45. 000000000000000000
Presentation Position

48. Signs
Fetal heart sound can be heard
at rate varies from 120 to 160
beats per minute.
The fetal body can usually be
palpated by the 18th to 20th week
of gestation unless the patient is
too fat, the abdomen is tender or
there is an excessive amount of
amniotic fluid.

49. Fetal heart

50. Fetal heart
(uterine souffle and umbilical souffle)

51. Ballotment
External ballottement: can be elicited at 20 weeks
by a push to the foetal parts with one hand
abdominally and the other hand receiving the
impulse.
Internal ballotment – 16-28 week
Repercussion is felt when the fetus is given a push
with two fingers in the anterior fornix.

54. ballottement

55. Other Examinations
Ultrasonography.
X-ray. It is rarely used recently
because the harmfulness to the fetus.
Fetal electrocardiogram. A fetal
electrocardiogram can first be
recorded at about the 12th week of
pregnancy.

56.  ULTRASONOGRAPHY.—
 Routine sonography at 18-20 weeks permits
adetailed survey of fetal anatomy , placental
localization and the integrity of the cervical canal.
Gestational age is determined by measuring the
biparietal diameter (BPD), HEAD CIRCUMFERENCE (HC),
ABDOMINAL CIRCUMFERENCE (AC), and FEMUR LENGTH
(FL).
OTHER EXAMINATIONS

58. https://www.youtube.com/watch?v=O
BV7i9zRAto

59. Last trimester
Amenorrhoea
Enlargement of abdomen
Lightening
Frequency micturition

60. Different methods of pregnancy diagnosis

61. 
 -Salivation,
 -heaviness,
 -malaise,
 -drowsiness,
 -horrpilation,
 -distress in cardiac region,
 -contentment,
 -holding up of zygote in uterus– these are the symptoms of the conception
which has just taken place.

62. 
 SUSHRUTA has mentioned-
 -fatigue,
 -languor,
 -thirst ( excessive ),
 -lassitude of thighs,
 -retention of shukra and shonita ( in yoni or absence of menstrual and coital --
discharge ) and
 -quivering in vagina etc.

63. 
Vyakta garbha Lakshana

64.  The management depends on knowledge which, in turn, depends on signs and
symptoms, hence description of signs and symptoms is necessary; such as–
 -disappearance of menstruation,
 -excessive salivation,
 -loss of desire for food, -vomiting,-anorexia, -liking for sour things,
 inclination towards good or bad things, -heaviness in body,
 -malaise in eyes,
 -appearance of milk in breasts,
 -excessive blackness in lips and the
 -areola of breasts,
 -slight edema in feet,
 -appearance of the line of small hairs,
 -dilatation of -vagina– these are the symptoms of pregnancy.

65. Vyakta garbha Lakshana

66. SIGN/ SYMPTYOMS IN FOURTH
MONTH……..
CHARAKA-
During the 4th month, the fetus attains stability
and as such the pregnant woman feels particular
heaviness in the body.
Sa4#20

67.  KASHYAP-

 kashyap- due to stability in the fetus woman feels more
heaviness in the body.

68.  CHARAKA---.

 During the 5th month, in fetus flesh and blood are
developed more in comparison
 to other months, hence the pregnant woman gets
particularly lean and thin.

Sa4#21
SIGN/ SYMPTYOMS IN FIFTH MONTH……..

69.  kashyap---

 kashyap also said that the pregnant woman is
emaciated in this month.

70.  CHARAKA-.

 During the 6th month, the fetus is developed more in
respect of strength and
 complexion, hence the pregnant woman particularly
loses strength and complexion
 . Sa4#22
SIGN/ SYMPTYOMS IN SIXTH
MONTH……..

71.  KASHYAP-.

 kashyap said the pregnant woman feels more tiredness.


72.  CHARAKA-.

 During the 7th month, the fetus is developed in respect
of all entities, hence the pregnant woman become
overall exhausted during the period.
Sa4#23
= SIGN/ SYMPTYOMS IN SEVENTH
MONTH……..

73.  KASHYAP-

 kashyap- he also said that the pregnant woman feels
exhausted

74. END