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Clinical Diagnosis of pregnancy Dr. Archana vikram Asst Prof

Clinical Diagnosis of pregnancy Dr. Archana vikram Asst Prof. Objectives. At the end of the session will be able to: Diagnose pregnancy from symptoms and signs. Calculate the gestational age. Define important terms related to pregnancy. Diagnosis of pregnancy. Symptoms Signs.

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Clinical Diagnosis of pregnancy Dr. Archana vikram Asst Prof

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  1. Clinical Diagnosis of pregnancyDr. Archana vikramAsst Prof

  2. Objectives • At the end of the session will be able to: • Diagnose pregnancy from symptoms and signs. • Calculate the gestational age. • Define important terms related to pregnancy.

  3. Diagnosis of pregnancy • Symptoms • Signs

  4. Symptoms of pregnancyfirst trimester (12 weeks) • Cessation of menstruation/ amenorrhoea • Morning sickness • Breasts discomfort- (6-8wks) • Fatigue • Increase in frequency of micturation(8-12weeks)

  5. Signs of pregnancy • Breast; Fullness, primary areola pigmentation, Montgomery's tubercles( hypertrophied sebaceous glands), reliable sign in Primigravida. Colostrum(12 wks) • Abdomen; • Palpation, uterus palpable at 12 weeks of gestation

  6. Vaginal examination • Vaginal mucosa; Jacquermin’s sign- vestibule and ant vaginal wall Dark Bluish colouration Chadwick’s sign(8 wk) • Osiander sign- pulsations in lat fornix(8 wk) • Goodells sign- soft cervix(6 wk) • Leukorrhea, increase in vaginal discharge(6 wk)

  7. Uterine signs • Size-egg(6 wk), cricket ball(8 wk), fetal head(12 wk) • Pisckacek sign-lat implantation n asymmetrical enlargement • Hegar’s sign of pregnancy(6-10wk) Bimanual palpation of soft uterine isthmus between the cervix and the body. Palmar sign-(4-8wk)rhythmic and regular contraction Soft n elastic-Cystic sensation of uterus by 8 weeks

  8. Hegar’s sign

  9. Second trimester(13-28wks) symptoms • Quickening • Progressive enlargement of lower abdomen

  10. signs • Face;(24 wks) Brown pigmentation, mask usually patchy (Cholasma) • Breast changes-prominent veins, sec areolar(20 wk), montgomery tubercles, colostrum –thick n yellow • Abdomen • Linea nigra, brown or black pigmentation-stretching of collagen and elastin. • Striae gravidarum, stretch marks, red or purple during pregnancy, turns on to white after pregnancy. Situated in the lower abdomen, breasts, thighs, buttock.

  11. Diagnosis of mid or late pregnancy Fetal movement (FM) • The first perception: in the 18th – 20th weeks • Diagnosis of pregnancy, duration of pregnancy, the safety of fetus • Count: 3 times per day, 1 hour per time. sum×4= FM/12 hours. Normal:≥ 30/12 hours

  12. Diagnosis of mid or late pregnancy Fetal heart tones • Heard: the 18th – 20th weeks • Normal rate: 120-160bpm • Differentiation: umbilical souffle Fetal body Palpated: outlines of the fetus (the 20th week).

  13. External ballotment • 20-28wks

  14. Vaginal signs • Bluish discoloration • Internal ballotment(16-28wk)

  15. Last trimester(29-40wk) • symptoms-amenorrhoea, enlargement of abdomen, lightening, frequency of micturation and fetal movements.

  16. SIGNS • UTERINE shape- cylindrical to spherical at 36wk • Fundal height • SFH • Braxton hicks contractions • Fetal movements • Palpation of fetal parts, Liquor • FHS

  17. Important terms • Braxton Hicks contractions; Occurs from first trimester painless spontaneous irregular do not lead to labour Lower uterine segment The thin expanded lower portion of the uterus( the isthmus), forms in the last trimester of pregnancy, after 32 weeks of gestation. It provides the usual method of approach to deliver the baby during Caesarean section (CS). Lightening Usually occurs after 36 weeks, more in primigravida. Mother notices that it is easier to breath.

  18. Differential dignosis • Pseudocyesis • Cystic ovarian tumor • Fibroid • Encysted peritonitis • Distended urinary bladder

  19. Calculation of the gestational age • Last menstrual period (LMP), regular, irregular, on the combined oral contraceptive pills, number of spontaneous cycles, bleeding in early pregnancy. • Expected date of delivery/ confinement (EDD, EDC), Estimated by regularity of periods, no immediate past oral pills, no bleeding in early pregnancy. Naegle’s rule, add one year subtract 3 months add 7 days

  20. Terms related to pregnancy • Term, It is a period of time . It is not the same as EDD • Preterm, before 37 completed weeks of gestation • Posterm, after 42 completed weeks of getation

  21. Thank you

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