DIAGNOSIS OF PREGNANCYJayashree ajith Asso.Prof.P.G.College of Nursing . C.H.R.I. Gwalior

Diagnosis of Early Pregnancy

SUBJECTIVE CHANGES

History and symptoms

1. Amenorrhea

1) The first and the most important symptom

2) emotional tension, chronic disease and certain medications → delayed menses endocrine factors

3) lactation, IUD and dysfunction of endocrine → pregnancy

CONT........

Psychological factors – emotional shock fear of pregnancy infection Systemic disease – tuberculosis ,

malignancy

Diagnosis of Early Pregnancy2. Morning sickness1) Fatigue, swirling, nausea and

vomiting (the 6th week↑ → the 12th week↓ ).

2) Hyperemesis gravidarum protracted vomiting necessitating hospitalization.

3) Causes: HCG, delayed gastric emptying(P↑ )

Diagnosis of Early Pregnancy3. Urinary symptoms1) Bladder irritability, frequency and

nocturia2) Causes: increased circulation in

pelvis (E and P↑), enlargement of the uterus.

3) urinary infection must be ruled out

Diagnosis of Early Pregnancy4. Mastodynia1) the development of mammary ducts

(E↑) and alveolar system (P↑)2) circulation↑→ engorgement of the

breasts5. Constipation smooth muscle relaxant (P↑)6. Weight gain

Diagnosis of Early Pregnancy OBJECTIVE SIGNS Signs1. The changes of pelvic organs1) Chadwick,s sign: Vagina bluish or purple

discoloration (congested pelvic vasculature). Increased vaginal discharge (E and P↑)

2) Cevix: softening and bluish discoloration. The cervical mucus→ a granular pattern

3) Uterocervical junctionHegar’s sign: a widened zone of softness

coupled with compressibility, resulting in a doughnut-shaped, slightly spongy configuration.(softening of the isthmus of the uterus

Hegar’s sign

Diagnosis of Early Pregnancy

4) Mcdonald,s sign .flexing the body of the uterus aganist the cervix

5) Abdominal enlargement Enlargement of uterus (noticed at

the 12th week)2. Breast changes1) Enlargement and vascular

engorgement (6th –8th week)2) Montgomery’s tubercles 6th –8th

week, E and P↑3) Colostrum secretion (16th week) or

secondary breasts

CONT......

6. Braxton Hicks Contraction- twenty eighth weeks.

7. Uterine souffle- Increase uterine blood flow and blood pulsating through the placenta

8. Changes in pigmentation of the skin – linea nigra, striae, facial cholasma

9. Ballottement-

Diagnosis of Early Pregnancy Laboratory tests1. Pregnancy test1) Urine HCG test (one step): + or –2) β-HCG: >25mIU/L2. Ultrasonography1) Enlargement of uterus2) Gestational sac3) Embryo or fetal pulse

Diagnosis of Early Pregnancy3. Other tests1) Progesterone test2) Cervical mucus examination3) Basal body temperature (BBT)

Diagnosis of mid or late pregnancy

Symptoms and signs1. EDC: +9 or –3 (month), +7 (day)2. Enlargement of uterus1) 12th week: 2 finger above the

symphysis2) 16th week: midway between the

symphysis and the umbilicus.3) 20th – 22nd week: at the umbilicus

Diagnosis of mid or late pregnancy

3. POSITIVE CHANGES4. 15Fetal movement (FM)1) The first perception: in the 18th –

20th weeks2) Diagnosis of pregnancy, duration of

pregnancy, the safety of fetus3) Count: 3 times per day, 1 hour per

time. sum×4= FM/12 hours. Normal:≥ 30/12 hours

Diagnosis of mid or late pregnancy

4. Fetal heart tones1) Heared: the 18th – 20th weeks2) Normal rate: 120-160bpm3) Differentiation: umbilical souffle 4) Fetal body Palpated: outlines of the fetus (the

20th week).

Diagnosis of mid or late pregnancy

Laboratory tests1. Ultrasonography1) The number of fetus2) Fetal lie3) Fetal presentation4) Fetal position5) Fetal dead or not 6) Placenta and cord (velocity of flow)7) Size of fetus

Fetal Attitude

Fetal lie Refers to the relationship of the

long axis of the fetus to the long axis of the mother

1. Longitudinal lie The long axis of the fetus is

parallel with that of the mother2. Transverse lie The long axis of the fetus crosses

that of the mother vertically

Fetal Attitude

Fetal presentation1. head presentation Occiput presentation (95%), brow

presentation and face presentation.2. Breech presentation1) Complete breech presentation2) Frank breech presentation3) Incomplete breech presentation:

footling presentation

Fetal Attitude

Fetal position Refers to the relationship of the

point of direction of the presenting part to one of the 4 quadrants of the pelvis or to the transverse diameter of the maternal pelvis.

1. Occiput presentation: the occiput, O. LOA,LOT,LOP

2. Face presentation: the chin, M. LMA,LMT,LMP

3. Breech presentation: the sacrum, S.LSA,LST,LSP

END

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