Pregnancy

1. BY DR REDIET TESFAYE
MD

2.  Describe signs and symptoms of pregnancy.
 Describe accuracy of gestational age.
estimation by different methods.
 Discuss some of pregnancy tests method

3.  Introduction
 First trimester symptoms and signs
 Second trimester symptoms and signs
 Third trimester symptoms and sign
 Differential diagnosis of pregnancy
 Clinical method of gestational age estimation
 Ultrasound in gestational age estimation
 Fetal weight estimation methods (clinical vs
U/S)

4.  Pregnancy is maternal condition of having
developing fetus in maternal body.
 Diagnosis of pregnancy is usually made on the basis
of a history of amenorrhea ,when a woman presents
with symptoms and signs and a positive pregnancy
test.
 The manifestations of pregnancy are classified into
three groups:
1, presumptive
2, probable
3, positive.

5. Subjective symptoms
 Amenorrhea : In otherwise healthy
,reproductive aged women having previous
normal periods is likely to be due to
pregnancy unless proved otherwise.
 Morning sickness:
More common in first pregnancy than
subsequent
Usually appears soon following missed
period
Rarely appears beyond 3 months
Usually doesn’t affect the health mother
It may characterized by vomiting ,,loss of
appetite and nausea.

6. Frequency of urination
 common during 8-12wks and 3rd
trimester
 disappears after 12wks as uterus
straightens up
Due to hormonal change and
mechanical factor.
Breast discomfort
 fullness and pricking sensation
 Early 6-8 wks,especially in primi
Fatigue – occur in early pregnancy is due to
the soporific effect of progesterone.

7.  Breast signs
Enlarged breast
Dark pigmented areola with tender nipples
Pelvic changes :may be informative in arriving
diagnosis.
 vaginal signs
 soft walls
 copious non irritating non foul
smelling discharge at 6wks.
 Cervical signs
 soft as early as 6th wks (Good ell's sign)
 cervix feels like lips of mouth
 cervix appears blue (Chadwick's sign)
 Uterine signs –soft and elastic
 size-at6th wk -size of hen’s egg
at 8th wk - size of cricket ball
at12th wk -size of fetal head
 position-acutely anteverted 6-8wk

8.  Symptoms
 nausea vomiting and frequency of
urination subsides.
 quickining usually felt at about 18th wks
,two weeks earlier in multi Para.
 progressive enlargement of lower
abdomen by growing uterus.
 Signs
Skin changes
Chloasma
Stria ,spider teleangectsia, palmar
erythema
breasts more enlarged.

9.  Abdominal examination
 linea nigra,striae
fundal height progressively
enlarged.
 fetal heart sound with fetoscope
detected b /n 18-20wks
Vaginal examination
 bluish discoloration of vulva
,vagina and cervix.

10.  Symptoms
 enlargement of abdomen produce some
mechanical discomfort
 a sense of relief of symptoms, at about
38wks,specially in primigravid,due to
engagement of presenting part
 frequency of micturation reappears
 more pronounced fetal movements
 Signs
Cutaneous changes prominent
Uterine shape change from cylindrical to
spherical beyond 36wks

11.  Symphsis fundal height(cm)
 after 20-24 wks corresponds to
number of wks up to 36wks
 variation of 2-3cm is accepted as
normal
 Braxton-Hicks contraction- are more evident
 Fetal movements are easily felt
 Palpation of the fetal parts and their
identification becomes more easier
 FHB is heard distinctly in areas
corresponding to presentation and position.

12.  Presumptive symptoms and signs
 includes features mainly
appreciated by the women
 amenorrhea
 frequency of urination
 morning sickness
fatigue
breast changes
skin changes
Quickening
Basal body temperature
elevation
In summary

13.  abdominal enlargement
 Braxton-Hicks contraction
softening of the cervix(Goodell’s
sign)
 changes in shape ,consistency,
size of uterus
 Positive or absolute signs
 palpation of fetal parts and perception of active
fetal movement by examiner at 20 wks
 auscultation of fetal heart sounds
 Ultrasound evidence of embryo as early as 6th week
 radiography cal demonstration of fetal skeleton at
16th week onwards

14.  Cystic ovarian tumors
 Fibroids,
 Encysted peritonitis
 Distended urinary bladder etc.

16.  Determination of the correct gestational age is one
of the most important aspects of prenatal care.
 estimation of pregnancy dates is important :-
 mother, to know when to expect the
birth of her baby,
 choose the time at which to perform
various screening tests and assessments
, which include serum screening,
assessment of maturity, chromosomal
anomalies etc
diagnosis of intra uterine growth
restriction.
Make correct management decisions for
conditions such as preterm labor,
postdates pregnancy, and preeclampsia
etc.

17.  Basic methods used to estimate gestational
age (GA) are menstrual history, clinical
examination, and ultrasonography.
 In rare cases, the date of coitus is known, and
this may be useful in calculating the length of
pregnancy.
 Menstrual history :-Gestational age (GA) has
traditionally been estimated from the date of
the last menstrual period (LMP) ,280days
 Accurate LMP: - most reliable clinical
estimator of gestational age .

18.  Naegele's rule:-using European calendar.
LNMP +3 MONTHS + 7 DAYS
 Ethiopian calendars
LNMP+ 9 months +10 days if pagume is not passed
LNMP+ 9 months + 5 if pagume is passed ( 4 in leap year )
Calculate gestational age in completed weeks and days
 Date of quickening
It is the first time the mother felt fetal movement
In primigravida it is around 18-20 weeks and in
multigravida at 16-18 weeks of gestational age
Used to date pregnancy if LNMP is unknown.

19. Audible fetal heart tones
in addition to being absolute evidence
of pregnancy, are another marker of
gestational age.
 at 18 to 20 weeks using
ordinary stethoscope
 Using electronic Doppler device
permits detection by 10 to 12
weeks.

20. First trimester U/S
 Fetal viability and gestational age.
 gestational sac and yolk sac- by 5
-6 wks.
 fetal pole and cardiac activity-
6wks
 Two methods are commonly used for
determining the gestational age in the first
trimester.
mean sac diameter (MSD) and
crown-rump length (CRL)

22. CRL - maximum distance from the
cephalic pole to the caudal pole.
CRL regarded as highly
accurate in determining the
gestational age in early
pregnancy.
 It is less accurate in late trimesters.

24.  In late trimesters we use HC,AC and FL to
estimate GA.

25.  Maternal self estimation
 Leopold maneuvers
◦ Fundal height measurment.
25

26.  William’s obstetrics 22nd ed
 Green book for health science students
 Gabbe obstetrics 5th ed
 Up-to-date 19.3