Diagnosis of pregnancyis based on :
1- Symptoms and signs.
2- Positive pregnancy test.
3- Pelvic ultrasound.
3.
Symptoms and Signof
pregnancy :
First Trimester:
Symptoms:
- Amenorrhea.
- Morning sickness (nausea with or without
vomiting).
- Frequency of micturition.
- Breast enlargement, heaviness, pain.
- Changes of appetite
- Some women sleepy and depressed or
irritable and suffer insomnia
Signs:
- Breast Signs: hyperpigmentation of
nipple and areole, Increase in size and
sensitivity of nipples and breast.
- Hegar Sign: softening of uterus isthmus
- Chadwick’s Sign: darkening (violet) of the
cervix, vagina, vulva.
- Goodell’s Sign: softening of the vaginal
portion of the cervix.
4.
Second Trimester:
Symptoms:
- Amenorrhea.
-Breast symptoms become more marked.
- Quickening: is the first time mother
feels fetal movement (usually between
16 – 18 weeks in multigravida and 18 -20
weeks in primigravida).
- Progressive abdominal enlargement.
- Disappearance of morning sickness and
frequency of micturition.
Signs:
- Uterus is felt abdominally
- Braxton Hisks contractions
- Ballottement sign: depends on the presence
of solid body(fetus) in fluid medium.
(detected between 16th
-28th
weeks)
- Palpation of fetal parts as early as 24 weeks.
- Appearance of striae gravidarum and linea
nigra.
- Auscultation of fetus heart sound.
5.
Third Trimester:
Symptoms:
- Amenorrhea.
-Breast symptoms become more marked.
- Progressive abdominal enlargement.
- Backaches
- Shortness of breath
- Heartburn
- Frequency of micturition.
6.
Pregnancy test:
Measurement ofHuman Chorionic Gonadotropin (β-HCG)
- Urine β-HCG test:
Can be detected in urine 14 days after fertilization.
- Serum β-HCG test:
Can be detected in serum 6 – 9 days after fertilization.
Can detect 1 mIU/ml
7.
Causes of aFalse Positive urine pregnancy
test:
- Proteinuria.
- Haematuria.
- Tumors as Choriocarcinoma.
- Immunologic disease as SLE
- Alkaline urine
- Exogenous HCG administered
- Drugs as penicillin and phenothiazines.
Causes of a False Negative urine pregnancy
test:
- Preforming the test too soon.
- Diluted urine
- Urine stored for long.
8.
Ultrasound:
Ultrasound findings innormal pregnancy:
- At 5 weeks: detection of gestational sac.
- At 5 – 6 weeks: detection of yolk sac.
- At 6 – 7 weeks: detection of fetal pole and cardiac activity with transvaginal ultrasound.
- At 10 – 12 weeks: detection of fetal heartbeat with Doppler ultrasound.
- At 18 – 20 weeks: detection of fetal movement.
- Energy intake:2200 – 2900 kcal/day.
- Protein: minimum daily nutritional goal 71 g/day (1.1 g/kg/day).
- Carbohydrate: requirements increase to 175 g/day.
- Fiber: 28 -36 g/day.
- Fat: should be restricted.
- Vitamins: all are needed in increased during pregnancy.
- Minerals: iron, calcium, iodine.
- Minimize caffeine intake.
- Avoid smoking and alcohol.
14.
In case ofDeficiency of some nutrients:
- Vitamin B6 deficiency: may cause vomiting.
- Vitamin B12 deficiency: megaloblastic anemia in the mother, neural tube defect in fetus and
intrauterine growth restriction.
- Vitamin C deficiency: scurvy and postpartum hemorrhage.
- Vitamin D deficiency: osteomalacia in mother and rickets in the child.
- Vitamin K deficiency: postpartum haemorrhage.
- Iron deficiency: anemia the mother.
- Calcium deficiency: osteomalacia in mother and rickets in the child, predisposes to cramps,
muscle twitches or pain in pelvic bone and back.
- Iodine deficiency: may lead to congenital goiter and goiter in mother.
