diagnosis of pregnancy- signs and symptoms, investigations

1. Diagnosis of pregnancy

2. Introduction
• Pregnancy is a condition of carrying a developing fetus in the uterus.
• It is a physiological state, but the diagnosis of pregnancy is very important.
• Usually, the woman is aware of the likelihood, or at least the possibility of
pregnancy when she consults an obstetrician.
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3. Continue…
• Anatomical & physiological changes occurring during pregnancy are
responsible for those signs and symptoms points towards pregnancy.
• These symptoms and signs are classified into three groups:-
1. Subjective evidence
2. Probable signs
3. Positive signs of pregnancy
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4. Subjective evidence of pregnancy
1. Amenorrhea
2. Morning sickness
3. Frequency of micturition
4. Feeling tired
5. Breast discomfort
6. Quickening
7. Abnormal appetite
Signs
1. Breast changes
2. Skin changes
3. Jacquemier’s/Chadwick’s sign
4. Osiander’s sign
Symptoms
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5. Probable signs of pregnancy
1. Uterine changes in shape, size and softness
• Hegar’s sign
• Palmer’s sign
2. Abdominal enlargement
3. Changes in cervix- Goodell’s sign
4. Braxton Hicks Contractions
5. Ballottement
6. Outlining the fetus
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6. Probable signs of pregnancy
Detection of chorionic gonadotropins in urine or serum
1. Immunoassay without
radioisotopes
a) Agglutination inhibition tests
b) Direct agglutination tests
c) ELISA
d) Immunofluorometric assay
2. Immunoassay with
radioisotopes
a) Radioimmunoassay
b) Immunoradiometric assay
c) Radioreceptor assay
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7. Positive signs of pregnancy
• Palpation of the fetal parts & perception of active fetal movement by 20 wks. of
gestation
• Auscultation of fetal heart sound (18-20 wks.)
• Fetal cardiac action by doppler equipment (10 wks.)
• Ultrasonic recognition of pregnancy
 White gestational ring by 5th wks.
 Fetal pole and yolk sac by 6th wks.
 Cardiac pulsation visible at 7th wks.
 Embryonic movement at 8th wks.
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8. Chronological appearance of specific signs &
symptoms of pregnancy
First Trimester
Symptoms
• Amenorrhea
• Morning sickness
• Loss of appetite
• Tiredness
• Increased frequency of micturition
• Fatigue
• Breast discomfort
Signs
• Breast enlargement, engorged, visible blood vessel under
skin
• Increased pigmentation of areola & nipple
• Jacquemier’s sign
• Cervical softening and bluish discolouration
• Osiander’s sign
• Hegar’s sign
• Palmer’s sign
• Uterine enlargement from hen’s egg to medium sized
orange
• Immunological test positive
• Sonographic appearance of gestational ring
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9. Chronological appearance of specific signs &
symptoms of pregnancy
Second Trimester
Symptoms
Early Second Trimester
• Amenorrhea
• Fatigue
• Breast discomfort
Signs
Early Second Trimester
• Increased pigmentation of primary areola &
appearance of Montgomery tubercles & colostrum
• Uterus midway between pubic symphysis & umbilicus
• Braxton Hicks Contractions
• Uterine souffle, internal ballottement
• Appearance of sonographic evidence
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10. Chronological appearance of specific signs &
symptoms of pregnancy
Second Trimester
Symptoms
Late Second Trimester
• Amenorrhea
• Quickening
Signs
Late Second Trimester
• Secondary areola, linea nigra Braxton hicks
contraction, external ballottement (20 wks.)
• Quickening, FHS (20 wks.)
• Internal ballottement (16-28 wks.)
• Uterus at the level of umbilicus (24
th
wks.)
• Sonographic evidence
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11. Chronological appearance of specific signs &
symptoms of pregnancy
Third Trimester
Symptoms
• Amenorrhea
• Perception of fetal movement
• Reappearance of increased frequency
of micturition
• Palpitation & breathlessness
• Lightening
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