This document discusses the diagnosis of early and mid-late pregnancy. It outlines several subjective and objective signs that can indicate pregnancy, including amenorrhea, morning sickness, breast changes, fetal movement, and fetal heart tones detectable by ultrasound. Laboratory tests that can confirm pregnancy include urine and blood tests to detect human chorionic gonadotropin and ultrasound to visualize the gestational sac, embryo, or fetus. In mid-late pregnancy, quickening may be felt at 18 weeks, the uterus enlarges and rises out of the pelvis, and fetal presentation, position, and growth can be evaluated by ultrasound.

1. Diagnosis of Pregnancy
Jayashree ajith DIRECTOR NURSINH JINR
GWALIOR

2. Diagnosis of Early
Pregnancy
 SUBJECTIVE CHANGES
 History and symptoms
1. Amenorrhea
1) The first and the most important symptom
2) emotional tension, chronic disease and certain
medications → delayed menses endocrine
factors
3) lactation, IUD and dysfunction of endocrine
→ pregnancy

3. CONT........
 Psychological factors – emotional shock
 fear of pregnancy infection
 Systemic disease – tuberculosis ,
malignancy

4. Diagnosis of Early
Pregnancy
2. Morning sickness
1) Fatigue, swirling, nausea and vomiting (the
6th week↑ → the 12th week↓ ).
2) Hyperemesis gravidarum protracted
vomiting necessitating hospitalization.
3) Causes: HCG, delayed gastric emptying(P↑ )

5. Diagnosis of Early
Pregnancy
3. Urinary symptoms
1) Bladder irritability, frequency and nocturia
2) Causes: increased circulation in pelvis (E and
P↑), enlargement of the uterus.
3) urinary infection must be ruled out

6. Diagnosis of Early
Pregnancy
4. Mastodynia
1) the development of mammary ducts (E↑)
and alveolar system (P↑)
2) circulation↑→ engorgement of the breasts
5. Constipation
smooth muscle relaxant (P↑)
6. Weight gain

7. Diagnosis of Early
Pregnancy
 OBJECTIVE SIGNS
 Signs
 Breast changes
1. The changes of pelvic organs
1) Chadwick,s sign: Vagina bluish or purple discoloration
(congested pelvic vasculature). Increased vaginal discharge (E
and P↑)
2) Cevix: softening and bluish discoloration. The cervical
mucus→ a granular pattern goodell,s sign
3) Uterocervical junction
Hegar’s sign: a widened zone of softness coupled with
compressibility, resulting in a doughnut-shaped, slightly
spongy configuration.(softening of the isthmus of the uterus

8. Hegar’s sign

9. Diagnosis of Early
Pregnancy
4) Mcdonald,s sign .flexing the body of the uterus
aganist the cervix
5) Abdominal enlargement
Enlargement of uterus (noticed at the 12th
week)
2. Breast changes
1) Enlargement and vascular engorgement (6th –
8th week)
2) Montgomery’s tubercles 6th –8th week, E and
P↑
3) Colostrum secretion (16th week) or secondary
breasts

10. CONT......
6. Braxton Hicks Contraction- twenty eighth
weeks.
7. Uterine souffle- Increase uterine blood
flow and blood pulsating through the
placenta
8. Changes in pigmentation of the skin –
linea nigra, striae, facial cholasma
9. Ballottement-

11. Diagnosis of Early
Pregnancy
 Laboratory tests
1. Pregnancy test
1) Urine HCG test (one step): + or –
2) β-HCG: >25mIU/L
2. Ultrasonography
1) Enlargement of uterus
2) Gestational sac
3) Embryo or fetal pulse

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

13. Diagnosis of mid or late
pregnancy
 SECOND TRIMESTER
 Symptoms
 Quickening feeling opf life felt in 18 th week
 GENERAL Examinaton
 Cholasma pigmentation over the head and cheek
 BREAST CHANGES secondary areola 2oth week
montagomery,s tubercle prominent colostrums become thick
16th week striae r visible.
1. EDC: +9 or –3 (month), +7 (day)
2. Enlargement of uterus
1) 12th week: 2 finger above the symphysis
2) 16th week: midway between the symphysis and the umbilicus.
3) 20th – 22nd week: at the umbilicus

15. Diagnosis of mid or late
pregnancy
3. POSITIVE CHANGES
4. 15Fetal movement (FM)
1) The first perception: in the 18th – 20th weeks
2) Diagnosis of pregnancy, duration of
pregnancy, the safety of fetus
3) Count: 3 times per day, 1 hour per time.
sum×4= FM/12 hours. Normal:≥ 30/12 hours

16. Diagnosis of mid or late
pregnancy
4. Fetal heart tones
1) Heared: the 18th – 20th weeks
2) Normal rate: 120-160bpm
3) Differentiation: umbilical souffle
4) Fetal body
Palpated: outlines of the fetus (the 20th week).

17. Diagnosis of mid or late
pregnancy
 Laboratory tests
1. Ultrasonography
1) The number of fetus
2) Fetal lie
3) Fetal presentation
4) Fetal position
5) Fetal dead or not
6) Placenta and cord (velocity of flow)
7) Size of fetus

18. Fetal Attitude
 Fetal lie
Refers to the relationship of the long axis of
the fetus to the long axis of the mother
1. Longitudinal lie
The long axis of the fetus is parallel with that
of the mother
2. Transverse lie
The long axis of the fetus crosses that of the
mother vertically

19. Fetal Attitude
 Fetal presentation
1. head presentation
Occiput presentation (95%), brow
presentation and face presentation.
2. Breech presentation
1) Complete breech presentation
2) Frank breech presentation
3) Incomplete breech presentation: footling
presentation

20. Fetal Attitude
 Fetal position
Refers to the relationship of the point of direction
of the presenting part to one of the 4 quadrants
of the pelvis or to the transverse diameter of the
maternal pelvis.
1. Occiput presentation: the occiput, O.
LOA,LOT,LOP
2. Face presentation: the chin, M. LMA,LMT,LMP
3. Breech presentation: the sacrum,
S.LSA,LST,LSP

22. END
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