Diagnosis of Pregnancy

DIAGNOSIS OF PREGNANCYDIAGNOSIS OF PREGNANCY

Reproductive period of women begins at menarche & ends in menopause

I:e 13 to 45 yrs

Duration of pregnancy10 Lunar months / 9 Calendar months 7days280 days / 40 wks

Calculated from first day of last menstrual period Called as menstrual age / GAFertilization age – 266 daysOvulation – 266 days

Subjective Symptoms Amenorrhoea Missing of period Morning sickness Present in 50% of casesNausea / Vomiting / Loss of appetite

Frequency of urine Pressure of enlarged uterus on bladderCongestion of bladder mucosa Breast discomfort / Giddiness / Fatigue

Breast Nipple / areola – pigmented Montgomery’s tubercles prominent

PA - Uterus not palpable Jaequemier’s sign / Chadwick's signBluish colouration of vagina – local vascular

congestion Nonirritating mucoid discharge vascularity

Goodell’s sign Cx softened - vascularity Uterus enlarged, soft , elastic Hegar’s sign Softened interned os

Palmer’s sign Regular & rhythmic uterine contractions

during bimanual Cx

Immunological tests for diagnosis of pregPrinciple Detection of hCG antigen in maternal urine &

serum Various kits available

Gravindex test – slide test Put one drop of urine on the slide If one line present - not pregnantIf two lines present - pregnant

Selection of time 8 to 11 days after conception i:e within a wk after missing of periodNot reliable after 12 wks

Collection of urine First voided urine in the morning Container not to be washed with soap

Uses of preg testsTo confirm intra uterine pregnancyTo diagnose ectopic pregnancyTo monitor or follow up molar pregnancy &

chorio carcinoma

Test accuracy 98.6 to 99%Non preg level – 1 mIU / mlLimitations – Accuracy affected, due toHaemoglobin, Albumin, LH, Immunological

diseases

Advantages Simple / speed / accuracy / less cost

USGIntra uterine gest sac + Yolk sac - 5th wkFoetal pole, cardiac activity – 6 wksEmbryonic movements – 7 wksGA – 7 & 12 wks

Symptoms Quickening Perception of active foetal movements – 18

wksProgressive enlargement of uterus

Signs Chloasma – pigmentation over forehead

– checks – 24 wksBreasts – enlarged with prominent veins

Secondary areola – 20 wksMontgomery tubercles over secondary areola Colostrum – thick & yellowish – 16 wksLinear pigmented line – linea nigra & striae - 20 wks

Striae Both pink & white

Fundal height – increased progressively Just palpable – 14 wksBetween symphisis & umbilicus – 16 wksAt umbilicus – 24 wks

Xiphi sternum – 36 wks3 fingers above – umbilicus – 28 wks6 fingers above – umbilicus – 32 wks

Palpation foetal parts – 20 wksActive foetal movements – 20 wks External ballottement – 20 wks

Fetal Heart SoundsAuscultation of FHS – 18 to 20 wks120 – 160 beats per min / over – 140Uterine soufflé Systolic murmur synchronous with maternal

pulse due increased blood flow through dilated uterine vessels

Funic or foetal soufflé Rush of blood through umbilical arteries –

soft, blowing murmur synchronous with foetal heart sounds

Investigations Sonography – 18 to 20 wksdetailed exam for foetal anatomy, placental

localization, integrity of Cx canal

For GA BPD / HC / AC / FLMRI : To rule out anomalies X- ray – foetal skeleton – 16th wk

Amonorrhoea persists Progressive enlargement of abd

Lightening at 38 wks – Shelving signFalling forward of utEngagement of presenting part Liquor

Foetal movements / FH Sounds present Foetal parts FHS not heard – IUD / obesity / polyhydramniosSonography

Differential diagnosis Abdomino pelvic massDistended bladderUterine fibroid Cystic ovarian tumour Encysted tubercular peritonitis Haematometra