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DIAGNOSIS OF PREGNANCY

DIAGNOSIS OF PREGNANCY. Signs and symptoms of pregnancy. Presumptive signs lead a woman to believe that she is pregnant. Probable signs are highly suggestive of the diagnosis of pregnancy. Positive signs of pregnancy: ascertain the presence of pregnancy. Presumptive signs and symptoms.

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DIAGNOSIS OF PREGNANCY

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  1. DIAGNOSIS OF PREGNANCY Mrs.Mahdia Samaha Kony

  2. Signs and symptoms of pregnancy • Presumptive signs lead a woman to believe that she is pregnant. • Probable signs are highly suggestive of the diagnosis of pregnancy. • Positive signs of pregnancy: ascertain the presence of pregnancy. Mrs.Mahdia Samaha Kony

  3. Presumptive signs and symptoms a) Amenorrhoea: 4+ weeks • Following imlpantation of the fertilized ovum the endometrium undergoes decidual change and menstruation does not occur throughout pregnancy. • Amenorrhoea almost invariably accompanies pregnancy and in sexually active woman, who has previously menstruated regularly, should be considered to be due to pregnancy unless this is disproved. Mrs.Mahdia Samaha Kony

  4. Amenorrhoea: • The absence of menses is not a reliable indication of pregnancy until 10 days or more after the time of expected onset of the menstrual period. • When a second menstrual period is missed, the probability of pregnancy is much greater. • Uterine bleeding somewhat suggestive of menstruation occurs occasionally after conception. • One or two episodes of bloody discharge, somewhat reminiscent of and sometimes mistaken for menstruation, are not uncommon during the first half of pregnancy. Such episodes are interpreted to be physiological, and likely the consequence of blastocyst implantation Mrs.Mahdia Samaha Kony

  5. Presumptive signs and symptoms b) Nausea and vomiting may be experienced:4- 14 weeks • Nausea and vomiting may decrease and for some women cease altogether around 12 weeks . Lacroix et al. (2000) report the mean duration of nausea to be 34.6 days with 50% of women relieved by 14 weeks' gestation. Mrs.Mahdia Samaha Kony

  6. Presumptive signs and symptoms of pregnancy c) Breast changes • Discomfort, tingling and a feeling of fullness of the breasts may be noticed as early as the third or fourth week of pregnancy, as the blood supply to the breasts increases. The superficial veins on both the chest and breasts dilate. • Around 16 weeks of pregnancy the breasts start to secrete a little clear fluid called colostrum. This persists throughout pregnancy and for the first few days after delivery until milk is produced. A secondary areola may appear Mrs.Mahdia Samaha Kony

  7. Presumptive signs and symptoms of pregnancy d) Frequency of micturation: • This is due to pressure from the enlarging uterus and increased vasculrity of the bladder. • Around 16 weeks Pressure on the bladder is relieved because the enlarging uterus has risen out of the pelvis, which reduces the frequency of micturation experienced by the woman. Mrs.Mahdia Samaha Kony

  8. Presumptive signs and symptoms e) Skin changes: • The linea nigra: Which is the line of pigmentation from the symphysis pubis to the umbilicus • The chloasma (mask of pregnancy). • The nipples become more prominent • Montgomery's tubercles are visible on the areola. • Secondary areola. Mrs.Mahdia Samaha Kony

  9. Presumptive signs and symptoms f) Quickening: • The first fetal movements may be felt by primigravidae at 19+ weeds and by multigravidae at 17+ weeks. • Quickening sometimes described as flutters and a feeling of bubbles coming to the surface' rather than recognizable movements, an unreliable indicator of gestational age. • At about 24 weeks fetal parts and movements may be felt on abdominal palpation. Mrs.Mahdia Samaha Kony

  10. Presumptive signs and symptoms g) Enlarged uterus: • At 12 weeks the enlarged uterus is just palpable above the symphysis pubis. • At 16 weeks the fundus of the uterus is midway between the upper border of the symphysis pubis and the umbilicus. • At 20 weeks the fundus of the uterus is just below the umbilicus. • Around 24 weeks the fundus can be felt just above the umbilicus. • From 28-40 weeks the fungus continues to rise until at 36 weeks it reaches the xiphisternum and remains at that level until the fetal head engages Mrs.Mahdia Samaha Kony

  11. Mrs.Mahdia Samaha Kony

  12. Presumptive signs and symptoms h. Chadwick sign: During the vaginal mucosa usually appears dark bluish or purplish-red and congested t. Mrs.Mahdia Samaha Kony

  13. Probable signs of pregnancy • Hegar's sign: The softening at the isthmus may be so marked that the cervix and the body of the uterus seem to be separate organs. In fact, the inexperienced examiner may mistakenly conclude that the cervix is a small uterus, and that the softened body of the fundus is an adnexal mass. • Osiander's sign: Pulsation of the uterine arteries through the lateral fornices can be detected. • Colustrum may be expressed from the breasts Mrs.Mahdia Samaha Kony

  14. Probable signs of pregnancy • Uterine soufflé; is a soft, blowing sound that is synchronous with the maternal pulse. • It is usually heard most distinctly near the lower portion of the uterus. • This sound is produced by the passage of blood through the dilated uterine vessels. • It also may be heard with any condition in which uterine blood flow is greatly increased, for example, with large uterine myomas or ovarian tumors. Mrs.Mahdia Samaha Kony

  15. Jacquemier's sign: Increased vascularity of the vagina and cervix result in a lilac discoloration of those tissues. • Enlargement of the uterus is noted and compared with the period of gestation. • Internal ballottement may he elicited from 16 weeks. Mrs.Mahdia Samaha Kony

  16. Probable signs of pregnancy • Braxton Hicks contraction • Pregnancy tests: • Urine pregnancy tests are very sensitive and may be positive as early as 1 week after embryo implantation or within days of the first missed menstrual period. • Radioimmunoassay for serum testing of the beta subunit of human chorionic gonadotropin (hCG) may be accurate up to a few days after implantation (or even before the first missed period). Mrs.Mahdia Samaha Kony

  17. The positive signs of pregnancy • Positive pregnancy test, possible from the day of the expected period. • False-positive hCG test results are rare (Braunstein, 2002). However, some women have circulating factors in their serum that may interact with the hCG antibody. • The most common are heterophilic antibodies, which are human antibodies directed against animal-derived antigens used in immunoassays. • Women who have worked closely with animals are more likely to develop such heterophilic antibodies. Mrs.Mahdia Samaha Kony

  18. With a sensitive test, the hormone can be detected in maternal plasma or urine by 8 to 9 days after ovulation. • The doubling time of plasma Hcg concentration is 1.4 to 2.0 days. • Levels increase from the day of implantation and reach peak levels at about 60 to 70 days. • Thereafter, the concentration declines slowly until at about 14 to 16 weeks. Mrs.Mahdia Samaha Kony

  19. The positive signs of pregnancy • Fetal heart sounds, which may be detected at; • 6weeks by US • 10 weeks using Sonicaid ultrasonic equipment. • 24 weeks' gestation these sounds can be heard with the Pinard fetal stethoscope. • FHR ranges from 110 to 160 beats/min and is heard as a double sound resembling the tick of a watch under apillow. • Because the fetus moves freely in amnionic fluid, the site on the maternal abdomen where fetal heart sounds can be heard best will vary. Mrs.Mahdia Samaha Kony

  20. The positive signs of pregnancy • The examiner may often hear other sounds, the most common of which are: 1. The funic (umbilical cord) "souffle."It is a sharp, whistling sound that is synchronous with the fetal pulse. 2. The uterine "souffle." 3. Sounds resulting from fetal movement. 4. Maternal pulse; the pulsation of the aorta is unusually loud. 5. Sounds from maternal intestinal peristalsis. Mrs.Mahdia Samaha Kony

  21. The positive signs of pregnancy • Fetal movements felt by the examiner; At or about 20 weeks, the examiner can begin to detect fetal movements. • Palpation of fetal parts. • Radiology shows the fetal skeleton at 14-16 weeks X-rays should the avoided, however, as irradiation can damage the developing fetus. • Ultrasonography. A gestational sac may be visualized at 5 weeks. Mrs.Mahdia Samaha Kony

  22. The positive signs of pregnancy • Ultrasonography. • The use of transvaginal sonography has revolutionized imaging of early pregnancy and its growth and development. A gestational sac may be demonstrated by abdominal sonography after only 4 to 5 weeks‘ grstational age. • By 35 days, all normal sacs should be visible • After 6 weeks, a heartbeat should be detectable. • Up to 12 weeks, the crown-rump length is predictive of gestational age within 4 days. Mrs.Mahdia Samaha Kony

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