1. 1

2. 2

3. 3

4. SIGNS AND
SYMPTOMS OF
PREGNANCY
&
DIAGNOSIS
OF PREGNANCY
&
MINOR AILMENTS IN
PREGNANCY
4

5. AMENORRHOEA
MORNING
SICKNESS
FREQUENCY
OF
MICTURATION
FATIGUE
LINEA NIGRA
CHLOASMA
QUICKENING
ENLARGEMENT
OF
ABDOMEN
5

6. INTRODUCTION TO
PREGNANCY
• It is the state of carrying a developing embryo
or fetus within the female body from
conception to birth. After the egg is fertilized
by sperm and then implanted in the lining of
the uterus, it develops into placenta and
embryo or fetus.
6

7. DURATION OF PREGNANCY
Usually 40 weeks
or
280 days or 10 lunar months
or
9 months and 7 days, calculated from the first
day of last menstrual period.
7

8. Beginning from the first day of last menstrual
period , It is divided into three trimesters, each
lasting three months.
 First trimester (First 12 weeks)
 Second trimester (13-28 weeks)
 Third trimester (29-40 weeks)
8

9. PRESUMPTIVE /
POSSIBLE SIGNS
OR
SUBJECTIVE SIGNS
POSITIVE
SIGNS
PROBABLE SIGNS
OR
OBJECTIVE SIGNS
2 31
FIRST
TRIMESTER
( FIRST 12
WEEKS)
SECOND
TRIMESTER
(13-28
WEEKS)
THIRD
TRIMESTER
(29-40
WEEKS)
SIGNS & SYMPTOMS OF PREGNANCY
9

10. Presumptive, Probable & Positive Signs
• Presumptive Signs Or Possible Signs:
Presumptive signs of pregnancy are maternal
physiological changes which the woman
experience and which, in most cases, indicate to
her that she is pregnant.
• Probable Signs: Probable signs of pregnancy
are maternal physiological changes other than
presumptive signs, which are detected upon
examination and documented by the examiner.
10

11. • Positive signs:- Positive signs are those
directly attributable to the fetus as detected and
documented by the examiner.
11

12. 12

13. SIGNS AND SYMPTOMS
IN
FIRST TRIMESTER
13

14. AMENORRHOEA
MORNING SICKNESS
FREQUENCY OF MICTURITION
BREAST DISCOMFORT
FATIGUE
FAINTING
SUBJECTIVE SYMPTOMS
14

15. IVE SIGNS OR SUBJECTIVE S
AMENORRHOEA
YMPTOMS
 Absence of menstruation in woman of
reproductive age.
However, cyclic bleeding may occur up to 12
weeks until decidua space is obliterated by the
fusion of decidua Vera with decidua capsularis.
(Implantation bleeding/ Placental sign)
Such bleeding is scanty, lasting for shorter
duration and corresponds with date of expected
periods.
15

16. MORNING SICKNESS
• It is present in about 50% cases, mostly during
first pregnancy.
• Nausea and vomiting begins about 6 weeks
after the last menstrual period and usually
disappears by about 14 weeks.
• It is due to the high level of pregnancy
hormones.
16

17. FREQUENCY OF MICTURITION
• It is present during 8-12 week of pregnancy
and subside after 12 weeks.
• Resting of bulky uterus on the fundus of the
bladder because of anteverted position of
uterus.
17

18. BREAST DISCOMFORT
• It is present during 6th week in the form of
feeling of :
*Tenderness.
*Tingling.
*Fullness.
*Increase in size.
*Pigmentation of areola.
* Pricking sensation.
18

19. FATIGUE
• It is frequent in early pregnancy and subside
around 12-14 weeks of pregnancy with
bringing renew energy.
19

20. OBJECTIVE SIGNS
BREAST CHANGES
CARDIO-VASCULAR CHANGES
RESPIRATORY CHANGES
INTEGUMENTARY CHANGES
MUSCULO-SKELETAL CHANGES
ABDOMEN AND UTERINE CHANGES
PELVIC CHANGES 20

21. BREAST CHANGES
• These are valuable only in primiparae, compared to
multiparae.
• Breast changes are evident between 6-8 weeks.
• There is enlargement with vascular engorgement
with delicate veins visible under the skin due to
increased blood supply, making the veins more
noticeable.
• Nipples and areola (primary) become more
pigmented or darker.
• Montgomery’s tubercles are prominent.
• The thick yellowish secretion (colostrum) can be
expressed as early as 12th week. 21

22. BREAST CHANGES
22

23. Appearance of Montgomery
tubercle in the areola
• dilated sebaceousglands
23

24. PELVIC CHANGES
Jacquemier’s or Chadwick’s sign:
• It is dusky hue of vestibule and anterior
vaginal wall visible at about 8th week of
pregnancy. The discoloration is due to local
vascular congestion.
Vaginal sign :
•Apart from bluish discoloration of the anterior
vaginal wall, walls become softened, copious
amount of non-irritating mucoid discharge
appears at 6th week. There is increased pulsation
felt through the lateral fornices at 8th week
called Osiander’s Sign. 24

25. Cervical signs :
• Cervix becomes soft as early as 6th week
( Goodell’s sign), the pregnant cervix
• Feels like lip of mouth, while in non-pregnant
state like tip of nose.
25

26. UTERINE CHANGES
A) Size, Shape and Consistency
 Uterus enlarged to:
• Size of hen’s egg at 6th week
• Size of cricket ball at 8th week
• Size of fetal head at 12th week
26

27. • Pyriform shape of non pregnant uterus
becomes globular by 12th week
• There may be asymmetrical enlargement
of uterus if there is lateral implantation.
 One half is more firm than other half. As
pregnancy advances, symmetry is restored,
uterus feels soft and elastic
27

28. B) Hegar’s sign:
 It is present in two third of cases.
 It can be demonstrated between 6-10 weeks.
 It is softening and compressibility of the
lower segment of the uterus felt on bimanual
examination ( Two fingers in anterior fornix and
abdominal fingers behind uterus).
28

29. HEGAR’S SIGN
29

30. C) Palmer’s sign:
• Regular rhythmic uterine contraction on
bimanual examination at 4-8 weeks.
30

31. DIAGNOSIS OF PREGNANCY
IN FIRST TRIMESTER
IMMUNOLOGICAL
TESTS
ULTRA
SONOGRAPHY
31

32. 1
TESTS:I) URINE PREGNANCY
• Agglutination test
• Dip stick test
• Enzyme linked monoclonal antibody tests.
II) SERUM PREGNANCY TESTS:
• Fluoro-immunoassay (FIA)
• Radioimmunoassay (RIA)
2 • Immuno-radiometric assay(IRMA)
• ELISA
IMMUNOLOGICAL TESTS
32

33. hCG
• Thishormone is only released by trophoblastic
tissueproduced by agrowing fetus and its
associatedplacenta.
• hCG is present in the maternal circulation as
either an intact dimer, alpha or beta subunit, and
degraded form, or beta core fragment
• Detection of HCG in maternal serum and urine is
evident only8-10 daysafter conception.
33

34. • hCG is detectable in the serum of
approximately 5% of patients 8 days after
conception and in more than 98% of patients
by day 11.
• Diagnostic levels in Urine seen only about 23-
24days after conception.
• Levels peak at 10-12 weeks' gestation and
then plateau before falling
34

35. Blood tests for hCG
• Used only in special cases
( bad obstetric history, suspicion of ectopic,etc.)
• Require special labs and expertise.
• Currently,4main hcg assays areused,
a) Radioimmunoassay
b) Immunoradiometricassay,
c) Enzyme – linked immunosorbent assay(ELISA)
d) Fluoroimmunoassay.
35

36. Radioimmunoassay
Sensitivity - 5 mIU/mL
Time to complete - 4 hours
• Postconception age when first positive - 10-
18 days
• Gestational age when first positive - 3-4
weeks.
36

37. Immunoradiometric assay (more sensitive)
Sensitivity - 150 mIU/mL
Time to complete - 30 minutes
• Post conception age when first positive -
18-22 days
• Gestational age when first positive - 4 weeks
37

38. Immunoradiometric assay (less sensitive)
Sensitivity - 1500 mIU/mL
Time to complete - 2 minutes
• Postconception age when first positive:- 25-
28 days
• Gestational age when first positive:- 5 weeks
38

39. • Enzyme-linked immunosorbent assay (more
sensitive)
Sensitivity - 25 mIU/mL
Time to complete - 80 minutes
• Postconception age when first positive - 14-17
days
• Gestational age when first positive - 3.5 weeks
39

40. Fluoroimmunoassay
Sensitivity - 1 mIU/mL
Time to complete - 2-3 hours
• Postconception age when first positive:- 14-
17 days.
• Gestational age when first positive:- 3.5
weeks.
40

41. ULTRASONOGRAPHY
• Intra decidual gestational sacis identified asearly
as29 –35 daysof gestation
• Gestational sac& yolk sac-5 menstrual weeks
• Fetal pole and cardiac activity –6weeks
• Embryonic movements -7 weeks
• Doppler effect of UScanpick heart rate reliably
by 10th week.
41

42. SECOND TRIMESTER
42

43. SIGNS AND SYMPTOMS
IN
SECOND TRIMESTER
43

44. AMENORRHOEA
SUBJECTIVE SYMPTOMS
ENLARGEMENT OF LOWER ABDOMEN
QUICKENING
44

45. SUBJECTIVE SYMPTOMS
• Such as nausea , vomiting and frequency of
micturition usually subside , only
amenorrhoea continues.
• Quickening - It is the perception of active
fetal movement during 18th week of
primigravidae and on 16th week in
multigravida.
• Progressive enlargement - of the lower
abdomen by the growing uterus.
45

46. GENERAL EXAMINATION:-
• Chloasma: Pigmentation over the
forehead and cheek may appear at about
24th week .
46

47. • Breast changes:
 Breast are more enlarged with prominent
veins.
 Secondary areola specially in present
primigravidae , appears at about 20th week .
47

48.  Colostrum becomes thickand yellowishby 16th
week
 Variabledegree of striae may be visible with
advancing weeks.
48

49. • ABDOMINAL EXAMINATION :
Inspection:-
• Linea nigra: Linear pigmented zone
extended from symphysis pubis to ensiform
cartilage. It may be visible as early as 20th
weeks.
• Striae (both pink and white) visible in the
lower abdomen.
49

50. 50
Striae Gravidarum

51. Palpation:-
Fundal height is increased with progressive
enlargement of the uterus .
• Uterus feels soft and elastic and become
ovoid in shape .
• Palpation of the fetal part can be felt by 20th
week.
• Braxton - Hicks contraction: Irregular
uterine contraction without cervical dilatation
and painless. 51

52. 52

53. • External ballotment- usually elicited as early
as 20th week of pregnancy when the fetus
relatively smaller than the volume of the
amniotic fluid.
53

54. Auscultation:-
• Fetal heart sound (FHS) is the most
conclusive clinical signs of pregnancy.
• Can be detected 18 to 20 weeks.
• Normal fetal heart sound 110 to 160 beats
per minute .
54

55. • Uterine soufflé- Is a soft blowing and
systolic murmur heard low down at side of
the uterus , best on the left side .
• Fetal soufflé- It is a soft , blowing murmur
synchronous with the fetal heart sounds.
55

56. VAGINALEXAMINATION:-
• Bluish discoloration- of the vulva , vagina and
cervix is much more evident , so also
softening of the cervix .
• Internal ballotment- can be elicited between
16 - 28th week.
56

57. DIAGNOSIS OF PREGNANCY
IN SECOND TRIMESTER
• SONOGRAPHY:
–Routine sonographyat 18 –20 weekspermits a
detailed survey of fetal anatomy, placental
localisation and the integrity of thecervical
canal.
• FETAL ORGAN ANATOMY :
–To detect anymalformation.
• FETAL VIABILITY
• RADIOLOGIC:
–16TH Week – Fetal Skeletal Shadow. 57

58. THIRD TRIMESTER
58

59. SIGNS AND SYMPTOMS
IN
THIRD TRIMESTER
59

60. SUBJECTIVE SYMPTOMS
• Amenorrhoea persists.
• Enlargement of the abdomen leading to
discomfort to the patient (palpitaion or dyspnoea
following exertion).
• Lightening: Sense of relief of the pressure
symptoms due to engagement of the presenting
part. It occurs at about 38th week of
pregnancy. It is specially in primigravidae.
60

61. • Frequencyof micturition reappears
• Fetalmovements are more pronounced
61

62. OBJECTIVE SIGNS
• Cutaneouschangesare more prominent
with increased pigmentation andstriae.
• Uterine shape:–from cylindrical to
spherical beyond 36th week
62

63. • Fundal Height (distance between the umbilicus
and ensiform cartilage)
 Junction of the upper and middle third at 32
weeks.
 Levelof ensiform cartilage at 36thweek
 Comesdown to 32 week level at 40th week
becauseof the engagement of the presenting
part.
63

64. • Symphysis Fundal Height:-
 Upper border of the fundus located by
ulnar border of the lefthand and point is
marked.
 Distance between the upper border of
the symphysispubis upto the point
marked is measuredin centemetre
 After 24 weeks, the SFHin cmcorresponds to
the number of weeksupto 36weeks.
64

65. • Braxton-Hickscontraction:–more evident.
• Fetalmovements:–easily felt
• Palpation of the fetal parts and their
identification become much easier.
• F.H.S :– heard distinctly.
65

66. DIAGNOSIS OF PREGNANCY
IN THIRD TRIMESTER
• Sonography:-
 Fetal growth assessmentcanbe made
more accurate.
• Amniotic fluid volume assessment:-
 For oligo / poly.
66

67. MINOR DISORDERS
DURING PREGNANCY
&
ITS MANAGEMENT
67

68. INTRODUCTION:
• Many women experience some minor
disorder during pregnancy.
• These disorder should be treated adequately as
they may escalate and become life-threatening.
• Minor disorder may occur due to hormonal
changes, accommodation changes, metabolic
changes and postural changes.
• Every system of body may affected by pregnancy.
68

69. DIGESTIVE SYSTEM
 Nausea and vomiting
 Constipation
 Acidity and heartburn
 Excessive salivation
(Ptyalism)
 Abdominal discomfort
 Pica
69

70. NAUSEA AND VOMITING
 Especially in the
morning, soon after
getting out of bed
 Usually common
in primigravidae
 50% women have both
nausea and vomiting,
25% have nausea only
and 25% are unaffected
 Most commonly
occurs during the
first 10 weeks
 Related to higher levels
of hcg 70

71. MANAGMENT
 Dietary changes
 Behavior modification
 Hospitalization may be necessary to
correct fluid and electrolyte imbalance
 Explanation, reassurance, and symptomatic relief are
sufficient.
 Avoid: Disagreeable odors and rich, spicy, or
greasy foods
 Drink water or other fluids between meals to avoid
dehydration and acidosis
 Medication: well-known over-the-counter drugs
should be administered only when absolutely
indicated and prescribed. 71

72. CONSTIPATION
 Quite common
ailment
 Atonicity of the gut
due to the effect of
progesterone,
diminished physical
activity and pressure
of the gravid uterus on
the pelvic colon,
sluggish bowel
function are the
possible explanations.
72

73. MANAGMENT
 Regular bowel habit may be restored.
 Emphasize ample fluids and
laxative foods and prescribe a
stool softener.
 Purgatives should be avoided because of
the possibility of inducing labor.
 Exercise and good bowel habits are helpful.
 Mineral oil is contraindicated because it
absorbs fat-soluble vitamins from the bowel
and leaks from the anus.
73

74. ACIDITY AND HEARTBURN
 Due to relaxation of the esophageal
sphincter & hiatus hernia
 Heartburn (pyrosis, acid
indigestion) results from
gastroesophageal reflux disease
(GERD) in almost 10% of all
gravidas
 In late pregnancy, this may be
aggravated by displacement of the
stomach and duodenum by the
uterine fundus
 Most likely to occur when the
patient is lying down or bending
over
74

75. MANAGMENT
 To avoid over eating and not to go to
bed immediately after the meal.
 Liquid antacids may be helpful
 Sleeping in semi-reclining position with high
pillows
 This hernia is reduced spontaneously after
delivery
 Symptomatic treatment, not surgery,
is recommended
 Hot tea and change of posture are helpful.
 Calcium-containing antacids & the histamine
H2-receptor antagonists are pregnancy
category B (e.g., Tums) to reduce gastric
irritation 75

76. EXCESSIVE SALIVATION
(PTYALISM)
 Increased secretion of saliva is observed
during pregnancy. It may be associated
with increased intake of starch, though
actual cause is not known.
76

77. MANAGMENT
 This problem is usually self-limiting and
may be overcome by decreasing intake
of carbohydrates.
 It is not associated with any adverse
pregnancy outcome.
77

78. ABDOMINAL DISCOMFORT
 Due to Pressure, pelvic heaviness, is
caused by the weight of the uterus on the pelvic
supports and the abdominal wall
 Round ligament tension, tenderness along the
course of the round ligament (usually the left)
during late pregnancy, is due to traction on this
structure by the uterus, which is displaced by the
large bowel to be rotated slightly to the right
 Flatulence and distention can be due to large
meals, gas-forming foods, and chilled beverages.
These are poorly tolerated by pregnant women
78

79. MANAGMENT
 Rest frequently, preferably in the
lateral re position
 Local heat and change of position
 Dietary modifications
 Regular bowel function should be maintained,
and exercise is beneficial
 Acetaminophen 0.3–0.6, 2–3 times daily may
be of value
 Intra abdominal disorders must be diagnosed
and
treated appropriately.
79

80. PICA
 This is term used when the mother craves
certain food or unnatural substances such as
coal.
 The cause is unknown but hormones and
changes in metabolism are thought to
contribute to this.
 If the substance craved are harmful to the
unborn baby, the mother must be helped to
seek medical advice.
80

81. MUSCULO-SKELETAL SYSTEM
 Fatigue
 Backache
 Leg cramps
 Round ligament pain
 Varicose veins
 Ankle edema
81

82. FATIGUE
 The pregnant patient is more subject to
fatigue during the last trimester of
pregnancy because of altered posture and
extra weight carried.
82

83. MANAGMENT
 Anemia and other systemic diseases must be
ruled out.
 Frequent rest periods are recommended.
83

84. BACKACHE
 Common problem (50%) in pregnancy.
 Physiological change that contribute to
backache are: joint ligament laxity (relaxin,
estrogen), weight gain, hyperlordosis and
anterior tilt of the pelvis.
 May be due to faulty posture and high heel
shoes, muscular spasm, urinary infection or
constipation. 84

85. MANAGMENT
 Excessive weight gain should be avoided.
 Rest with elevation of legs to flex the hips
may be helpful.
 Improvement of posture, well-fitted pelvic
girdle belt which corrects the lumbar
lordosis during walking and rest in hard bed
 Improvement in posture is often achieved by
the wearing of low-heeled shoes. To achieve
proper posture, the abdomen should be
flattened, the pelvis tilted forward, and the
buttocks tucked under to straighten the back.
85

86.  Massaging the back muscles, analgesics and
rest
 Back exercises under the supervision of a
rehabilitation physician, an orthopedist, or a
physical therapist.
 Recommend sleep on a firm mattress.
 Apply local heat and light massage to relax
tense, taut back muscles.
86

87. LEG CRAMPS
 Quite common, usually in the leg.
 Worse at night.
 The cause of leg cramps in pregnancy is
not known but it may be due to deficiency
vitamin B1 and of diffusible serum calcium
or elevation of serum phosphorus.
 It may due to ischemia and changes in ph or
electrolyte status.
87

88. MANAGEMENT
 Supplementary calcium therapy in tablet
or syrup after the principal meals may
be effective.
 Massaging the leg, application of local heat
and intake of vitamin B1 (30 mg) daily may
be effective.
 Sleep with the foot end elevation by 20 to
25 cm. once the cramps is occur gentle
kneading is effective.
88

89. ROUND LIGAMENT PAIN
• Stretching of the round ligaments during
movements in pregnancy may cause sharp
pain in the groins. This pain may be unilateral
or bilateral.
• It is usually felt in second trimester onwards.
This is more common in right side as a result
of dextrorotation of uterus.
• Pain may be awakening at night time
because of sudden roll over movements
during sleep.
89

90. MANAGEMENT
 Pain may be reduced by making movements
gradual instead of sudden.
 Local heat application is helpful.
 Analgesics are rarely needed.
90

91. VARICOSE VEINS
 Usually in the later months
 Due to obstruction in the
venous return by the
pregnant uterus.
 Due to smooth muscle
relaxation, weakness of the
vascular walls, and
incompetent valves.
91

92. MANAGEMENT
 For leg varicosities, elastic crepe
bandage movements and elevation of
the limbs during rest can give
symptomatic relief.
 Elevate legs above the level of her body
and control excessive weight gain.
 Avoid forceful massage (especially
downward, i.e., against venous return) and
point-pressure over the legs.
92

93. ANKLE EDEMA
Evidenced by marked gain
in weight or evidences of
preeclampsia.
Develops in at least two
thirds of women in late
pregnancy.
Due to water retention and
increased venous pressure
in the legs.
Generalized edema, always
serious, must be
investigated. 93

94. MANAGEMENT
 No treatment is required for physiological
edema or orthostatic edema.
 Edema subsides on rest with slight elevation
of the limbs.
 Diuretics should not be prescribed.
 Treatment is largely preventive and
symptomatic.
 The patient should elevate her legs frequently.
 Restrict excessive salt intake and provide
elastic support for varicose veins.
94

95. NERVOUS SYSTEM
 Insomnia
 Headache
 Carpal tunnel syndrome
95

96. INSOMNIA
 This is relatively common in late
pregnancy owning to the discomfort caused
by the fetal movements, frequency of
micturation, and difficulty in finding a
comfortable position.
 It may also due to some deep- seated anxiety
or fear.
96

97. MANAGEMENT
 Take rest in the afternoon.
 Drink a glass of warm milk at bed time.
 Tuck a pillow under the abdomen when lying
in lateral position.
 Talk about her fear and anxiety so that she can
have a sense of normality and lightness.
97

98. CARPEL TUNNEL SYNDROME
 Pain and numbness in the thumb,
index and the middle finger
 Weakness in the muscles for thumb
movements
 Due to compression effect on the median nerve
 Physiological changes in pregnancy with
retention of excess fluid are the common
cause. 98

99. MANAGEMENT
 Treatment is mostly symptomatic.
 A splint is applied during sleep time to the
slightly flexed wrist to give relief.
 It resolves spontaneously following delivery.
99

100. RESPIRATORY SYSTEM
BREATHLESSNESS:
 Breathlessness, not actual dyspnea,is a
progesterone effect.
 In non smokers and others free of cough or
allergic problems, breathlessness occurs as
early as the 12th week of pregnancy, and
most women have this symptom by the 30th
week.
100

101. MANAGEMENT
There is no effective treatment.
101

102. INTEGUMENTARY SYSTEM
SKIN:
 Some mothers complaints of generalized
itching, which often starts over the
abdomen.
 Due to have some connection with the liver's
response to the hormones in pregnancy and
with raised bilirubin levels.
102

103. MANAGEMENT
It clean soon after the
baby is born and comfort
can be gained from local
applications.
If a mother complaint of
vulvar irritation, infection
such as thrush, and
glycosuria as a result of
diabetes must be
excluded.
Washing with mild soap
and cotton underwear
might help to ease the
irritation. 103

104. URINARY SYSTEM
Urinary frequency, urgency, and stress
incontinence in multiparas are common,
especially in pregnancy.
Due to increased intra abdominal pressure and
reduced bladder capacity.
Suspect urinary tract disease if dysuria or
hematuria is present.
104

105. MANAGEMENT
 When urgency is particularly troublesome,
limit caffeine, spices, and popular beverages.
 An 8 oz glass of cranberry juice assists in
both maintaining urinary acidity as well
as decreasing urinary tract infections.
105

106. FOLLOWING CONDITIONS
REQUIRE IMMEDIATE ACTIONS:-
 Vaginal bleeding
 Reduced fetal movement
 Frontal or recurring headache
 Sudden swelling/edema
 Rupture of the membrane
 Premature onset of contraction
 Sudden nausea and sickness
 Epigastric pain
106

107. ANY QUERIES?
107

108. 108