Diagnosis of pregnancy
Part 2
Week Week
13 28
SYMPTOMS:
• The subjective symptoms —
• such as nausea, vomiting and frequency of
micturition usually subside, while amenorrhea
continues.
The new features
• The new features that appear are:
• “Quickening” (feeling of life) denotes the
perception of active fetal movements by
the women.
• It is usually felt about the 18th week, about 2
weeks earlier in multiparae
• Progressive enlargement of the lower
abdomen by the growing uterus.
“Quickening”
(Feeling of
life)
GENERAL EXAMINATION
• Chloasma: Pigmentation over the
forehead and cheek may appear at about
24th week.
• Breast changes: (a) Breasts are more
enlarged with prominent veins under the
skin (b)
• Secondary areola specially demarcated in
primigravidae, usually appears at about 20th
week
•.
Contd...
• (c) Montgomery’s tubercles are prominent and
extend to the secondary areola
• (d) Colostrum becomes thick and yellowish by
16th week
• (e) Variable degree of striae may be visible with
advancing weeks
ABDOMINAL EXAMINATION
• Inspection:
• (1) Linear pigmented zone (linea nigra)
extending from the symphysis pubis to
ensiform cartilage may be visible as early as
20th week
• (2) Striae (both pink and white) of
varying degree are visible in the lower
abdomen, more towards the flanks
Linea nigra
Striae Gravidarum
Striae in Pregnancy
Contd…
• Palpation:
• Fundal height is increased with
progressive enlargement of the uterus.
• Approximate duration of pregnancy can be
ascertained by noting the height of the uterus in
relation to different levels in the abdomen
Contd...
• The height of the uterus is midway between the
symphysis pubis and umbilicus at 16th week; at
the level of umbilicus at 24th week and at the
junction of the lower third and upper
two-thirds of the distance between the
umbilicus and ensiform cartilage at 28th
week.
The level of fundus uteri at different
weeks. Note the change of uterine shape
At the
umbilicus
Contd...
• The uterus feels soft and elastic and
becomes ovoid in shape.
• Braxton-Hicks contractions are evident
• Palpation of fetal parts can be felt
distinctly by 20th week
Contd…
• Active fetal movements can be felt at
intervals by placing the hand over the uterus
as early as 20th week.
• It not only gives positive evidence of
pregnancy but of a live fetus.
• External ballottement is usually elicited
as early as 20th week when the fetus is
relatively smaller than the volume of the
amniotic fluid
Contd...
• External ballotement is elicited as early as
20th week. When the fetus is relatively smaller
than the volume of the amniotic fluid.
Auscultation
• With an ordinary stethoscope, it can be detected
between 18–20 weeks.
• The rate varies from 110–160 beats per minute.
•
Using
Hearing Fetal heart Sound, using Fetal Doppler Stethoscope
Contd...
• Two other sounds are confused with fetal
heart sounds. Those are:
• 1. Uterine souffl e
• 2.Funic souffle
Contd...
• Uterine souffle:-is a soft blowing and
systolic murmur heard low down at the
sides of the uterus, best on the left side.
• The sound is synchronous with the
maternal pulse and is due to increase in
blood flow through the dilated uterine
vessels.
Contd...
• Funic or fetal souffle :--
• is due to rush of blood through the
umbilical arteries. It is a soft, blowing
murmur synchronous with the fetal heart
sounds.
VAGINAL EXAMINATION
• The bluish discoloration of the vulva,
vagina and cervix is much more evident,
so also softening of the cervix.
• Internal ballottement can be elicited
between 16–28th week
• The fetus is too small before 16th week and too
large to displace after 28th week.
• However, the test may not be elicited in cases with
scanty liquor amnii, or when the fetus is
transversely placed.
Internal Ballotement
(A) External ballottement; (B and C) Steps
showing how to elicit internal ballottement
A C
INVESTIGATIONS (Imaging Studies)
• Sonography:
• Routine sonography at 18–20 weeks
permits a detailed survey of fetal
anatomy, placental localization and the
integrity of the cervical canal.
• Fetal organ anatomy is surveyed to
detect any malformation.
Contd...
• Fetal organ anatomy is surveyed to
detect any malformation. Fetal viability
is determined by realtime ultrasound.
• Absence of fetal cardiac motion confirms fetal
death.
