DIAGNOSIS OF PREGNANCY
Aashika
Aashina
Adithyan
INTRODUCTION
• The total duration of pregnancy (38-40 weeks), is
divided into 3 trimesters.
• These are
• 1st trimester- 12 weeks
• 2nd trimester – 13- 28 weeks
• 3rd trimester – 29- 40 weeks
The diagnosis of pregnancy is studied and made
according to the changes occuring during these 3
trimesters. There are various signs and symptoms in
these trimesters , which will be discussed below;
First trimesters
• A) subjective symptoms:
• Amenorrhea – it means missing of menses. Some
women notice small blood discharge at the time
of first missed period. It is known as placental
(implantation )sign.
• Morning sickness – it is the feeling of nausea with
or without vomiting. It is usually seen in 50% of
women during second month. Mother feels loss
of appetite, but it does not affect the health of
the mother.
• Frequency of micturation – mother feels the urges to
pass urine again and again. It occurs mainly
because of the anteverted position of the uterus,
in which the gravid uterus puts pressure on
the fundus of the bladder. There is also
stretching of the bladder base due to the
backward displacemnt of the cervix, which
further irritates the bladder . After 12 weeks,
the uterus straighten up, and the symptoms
disappears.
• Breast discomfort – there is a feeling of fulness and
pricking sensation in the breast, feel by the
mother during 6-8 weeks.
• Fatigue – mother feels fatigued easily in the early
pregnancy.
• b) objective signs:
• Breast changes – the breast shows signs, such as enlargement
of breast with vascular engorgement. This results
in visualization of delicate veins under the skin, the
areola
becomes pigmented with appeareance of montgomerys
tubercules; a pale yellow secretion
expressed from(colostrum)
the nipple can be
in third month.
• Per abdomen – fundus of uterus is not felt in earlier
pregnancy . Till 12 weeks, it remains a pelvic organ at 12
weeks, a soft uterine fundus can be felt at superior border of
symbysis pubis.
• Pelvic changes –
1. Jacquemiers sign or chadwicks sign – it is the dusky hue of the
vestibule and anterior vaginal wall, occuring due to the local
vascular congestion at about 8 weeks of pregnancy.
• Cervical sign – or goodells sign – softening of ceervix, around
6th week.
• Vaginal sign – the wall of the vagina become soft and during
6th week , a non irritating mucous discharge appears. Around
8th
week , an increased pulsation is felt through the lateral
fornices, called osianders sign.
• Uterine sign – with the advancement in pregnancy , uterus
also keeps on increasing in size. Uterus is soft and elastic.
It is the size of mens egg at 6th week, size of cricket ball
at 8th week, size of fetal head by 12th week.
• Hegars sign – it is between 6-10 weeks. According to this sign,
when the uterus is palpated bimanually, the two
vaginal fingers can almost meet the abdominal
fingers, which shows that upper part of utreus is enlaeged
by growing ovum and the lower part is soft and empty.
• Palmers sign – it is bimanual examination
regular and rhythmic contractions can
be elicited as early as 4 – 6 weeks.
SECOND TRIMESTER
• A) subjective symptoms:
• Amenorrhoea
• Uterus enlargement
• Quickening - mother feels the active
fetal movements at around 16th week
(multigravida), 18th week (primigravida).
b) Objective signs
• Chloasma – pigmentation appears on face and
forehead around 24th week.
• Breast changes – from 20th week, pigmenation appears
around primary areola in breasts, which is called as
secondary areola. Breasts are more enlarged and
montomers tubercules are seen. Straiae become visible
and colostrum becomes thick and yellowish.
• Abdominal findings –
1. Inspection : after 20th week, there is appeareance of a linear
pigmentation in the middle of abdomen, extending
from symphysis pubis to ensiform cartilage called as linea
nigra. Various degree of straie also visible on the lower
abdomen.
2. Palpation : uterus is ovoid in shape, enlargement of
uterus, fundal height is also increased. Uterus is;
at 16th week – between symbsis pubis and umblicus.
at 20th week – 2.5 cm below umblicus
at 24th week – at the level of umblicus
at 28th week – between umblicus and xiphoid
sternum.
3. Braxton hicks contractions : women cannot feel
the contractions at this time , but these can be felt by
placing a palm on the uterus.
4. Active fetal movements : can also be felt by
placing the palms on the sides of the uterus.
5. Palpation of fetal movements: by 20th week,
fetal parts can be palpated.
6. External ballotment : around 20th week,
by keeping the mother in dorsal position, with
one hand tapping of uterus is done from one
side, while the other hand, which is kept
outstrched on the other side feels the impulse.
7. Ascultation : by 20th week , one can hear the
fetal sound with the stethoscope.normally –
FHS is 140- 160 /min.
There are other 2 sounds, uterine souffle and fetal
souffle.
Uterine souffle – soft blowing systolic murmur
which is heard low down at the sides of the
uterus.
Fetal souffle – soft blowing murmur with the
fetal heart sound . It is due to rush of blood
through the umblical arteries.
• Internal ballotment – around 16- 28
weeks , internal ballotment can
be is tooelicited
fetus , 16
small before asth weeks
the to elicit
sign.
• Clinical manifestation –ultrasonography – with
the help of sonography , gestational age is
determined.
THIRD TRIMESTER
• A) subjective symptoms:
• Amenorrhea
• Enlargement of the abdomen
• Pressure symptoms
• Fetal movements
• Lightening – it is the sense of relief felt by the
mother from the pressure symptoms due to the
engagement of the presenting part into the
pelvis.
• Objective signs:
• Skin changes
• Uterine shape – become cylindrical to
spherical
• Fundal height – increases
• Braxton hicks contractions
• Fetal movements and palpation of fetal parts
can more easily.
• ultrasonography
Signs of pregnancy
• 1. presumptive signs
• 2. probable signs
• 3. positive signs
Presumptive signs: this include maternal
physiological changes, which the women
experiences, indicating that she is pregnant.
Amennorhea
Nausea and vomiting in 1st trimester
Frequency of micturation in 1st trimester
• Fatique of mother
• Enlargement of breast
• Appeareance of montgomerys tubercles
• Expression of colostrum from nipples
• Pigmentation of skin (cholasma, linea nigra,
striae)
• Quickening
• Probable sign: these are maternal physiological
changes, which are detected upon examination
by the examiner.
• Changes in shape of uterus and enlargement in
the size.
• Positive pregnancy test through presence of HCG
in urine.
• Hegar’s sign
• Chadwick’s sign
• Osciander’s sign
• Goodell’s sign
• Ballotment of fetus.
• Braxton hicks contractions.
• Positive sign: these signs directly tell about
the presence of the fetus and are detected by
the examiner.
• Visualization of the fetus by ultrasound
• Visualization of fetal skeleton by x-ray
• F.H.S by ultrsound and later on by fetoscope
• Fetal movements palpable by examiner
• Visualization of fetal movements in late
pregnancy.
• Palpation of fetal parts.
DIFFERENTIAL DIAGNOSIS
• Emotional stress, illness, imbalance in hormones.
• Contrceptive pills
• Gastrointestinal disorders
• Urinary tract infection
• Intestinal movement
• Choriocarcinoma
• Hydatidiform mole
• Tumors
• Pelvic congestion
• Increased blood flow to uterus.
CONFIRMATORY TEST
• The confirmatory test carried during
pregnancy are:
1. Urinary immunological tests
Latex agglutination slide test
Immunochromatographic test
2.ELISA or radioimmunoassay (RIA)
3.Biological test, achhein and zondek test
1. Urinary immunological tests: it includes 2
test latex aggultination slide test: in slide test,
when
HCG antesera is combined with urine with
HCG
, if no agglutination appears, then the
pregnancy is positive. If there is visible
agglutination there is no pregnancy. This test
comes positive after 2 weeks of missed menses.
Immunochromatogrphic test: these test are
available in market as pregcolor card or
asccutest HCG . This test is more sensitive than
the former test and comes positive after 1 week
of missed menses.
• Elisa or radioimmunoassay (RIA): this test is
specially indicated in patients
with trophoblastic diseases. It can detect
HCG on the 8th day of fertilization, before
menses is missed.
• Biological test, achheim and zondek test : as
there is problem of available animals , this
test is no more used.
