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Diagnosis of Pregnancy

Diagnosis of Pregnancy. Dr. Weaam Fiak Almahfooth M.B.CH.B. ,D.G.O. ,F.I.C.M.S. ,A.B.C.O.G. Presumptive Signs and symptoms. cessation of menses/missed period nausea and/or vomiting breast changes urinary frequency Fatigue continued elevation of BBT in absence of infection

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Diagnosis of Pregnancy

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  1. Diagnosis of Pregnancy Dr. Weaam Fiak Almahfooth M.B.CH.B. ,D.G.O. ,F.I.C.M.S. ,A.B.C.O.G.

  2. Presumptive Signs and symptoms • cessation ofmenses/missedperiod • nausea and/orvomiting • breast changes • urinary frequency • Fatiguecontinued elevation ofBBT in absence ofinfection • Excessive salivation • Chadwick’s sign • Quickening, skin pigment changes

  3. Probable Signs • First Trimester: • Goodell’s Sign • Hegar’s Sign • Chadwick’s Sign

  4. Probable Signs • Second Trimester: • uterine enlargement • Braxton-Hicks contractions • uterine souffle • palpation of fetal outline

  5. Positive (diagnostic) • Fetal heartbeat • Palpation of fetal movement • Ultrasound • X-ray

  6. Diagnosis of Early Pregnancy • History and symptoms • Amenorrhea • The first and the most important symptom • Note 1: emotional tension, chronic disease and certain medications → delayed menses • Note 2: lactation, IUD and dysfunction of endocrine → pregnancy

  7. Diagnosis of Early Pregnancy • Morning sickness • Fatigue, nausea and vomiting (the 6th week↑→ the 12th week↓ ). • Hyper emesis gravid arum : protracted vomiting necessitating hospitalization. • Causes: HCG, delayed gastric emptying(P↑ )

  8. Diagnosis of Early Pregnancy • Easy fatigability, lassitude and sleepiness are fairly common. • Emotional Changes: Craving for certain foods, odors and particular objects, and disinclination to others may also be present.

  9. Diagnosis of Early Pregnancy • Urinary symptoms • Bladder irritability, frequency and nocturia • Causes: increased circulation in pelvis (E and P↑), enlargement of the uterus. • Note: urinary infection must be ruled out

  10. Diagnosis of Early Pregnancy • Mastodynia • the development of mammary ducts (E↑) and alveolar system (P↑) • circulation↑→ engorgement of the breasts

  11. Diagnosis In The First Trimester--Symptoms: • Enlargement of the breasts: This is often noticed early in pregnancy. • There is increased heaviness, tingling sensation and there may be discomfort or actual pain in the breasts.

  12. Diagnosis of Early Pregnancy • Constipation smooth muscle relaxant (P↑) • Weight gain

  13. Diagnosis of Early Pregnancy • Abdominal Enlargement :- • Women notice abd. Fullness in early pregnancy . • Later on the uterine enlargement become more evidant . • Some women feel that she is pregnant due to abd.enlargment but this enlargment due to other reason e.g ovarian cyst or fat .

  14. Diagnosis of Early Pregnancy • Quickening :- • In primigravida ;feel fetal movement at 18-20 week . • In multigravida ; feel fetal movement tow week earlier .

  15. Diagnosis of Early Pregnancy • Signs • The changes of genital organs • Vagina: bluish or purple discoloration (congested pelvic vasculature). Increased vaginal discharge (E and P↑) • Cervix: softening (Goodel sign) and bluish discoloration (Chadwick sign) . • The cervical mucus→ a granular pattern . • Uterocervical junction Hegar’s sign: a widened zone of softness coupled with compressibility, resulting in a doughnut-shaped, slightly spongy configuration.

  16. Diagnosis of Early Pregnancy • Signs • Enlargement of uterus :- • On bimanual examination ,the body of uterus is feel to be globular and as progressive enlargement occur the dx. Become more evident . • Softening of the uterus due to increased vascularity .

  17. Diagnosis of Early Pregnancy • Signs • Lowest part of body of uterus become soft at first , because of this on bimanual examination the globular fundus of uterus feel differ from still unsoft cervix . • This changes occures at 6-8 week of preg. • Called hegar sign • After that the cervix become more soft and whole uterus .

  18. Diagnosis In The First Trimester--Signs: • 3) Hegar’s sign: bimanual examination with two fingers in the anterior fornix and the fingers of the other hand on the abdomen behind the uterus, the internal and external fingers can be approximated due to the fact that the lower segment is soft and empty. The sign can be elicited between the 6th and 10th week of pregnancy, after which the sign becomes negative as the ovum has now filled the whole uterine cavity.

  19. Hegar’s sign

  20. Diagnosis of Early Pregnancy • Abdominal enlargement Enlargement of uterus (noticed at the 12th week) The uterus just above pupic symphesis then gradually increase . Intermittent painless contraction may be even when uterus is still in the pelvis (palmers signs) . Rise the uterus up into abdomen this intermittent cont. become more easily felt called (Braxton hicks contraction) .

  21. Diagnosis In The First Trimester--Signs: • Breast Signs: • Increased size and sensitivity of the breasts and nipples, Increased vascularity and the appearance of subcutaneous veins. • Dark pigmentation of the nipples and areola. • Development of the second areola, Increased prominence of the tubercles of Montgomery. • Secretion of colostrum.

  22. Diagnosis of Early Pregnancy • Laboratory tests • Pregnancy test • Urine HCG test (one step): + or – • β-HCG: >25mIU/L • Ultrasonography • Enlargement of uterus • Gestational sac • Embryo or fetal pulse

  23. Pregnancy Testing • Type of tests: urine and blood (serum) • Tests based on production of chorionicgonadotrophin (hCG) by thesyncitiotrophoblastic cells during earlypregnancy (hCG secreted into maternalbolldstream (plasma) then is excreted inmother’s urine.

  24. Pregnancy Testing • HCG is a glycoprotein consist of α and B subunit . Α subunit also present in pit. LH but B subunit is characteristic of HCG hormone . • Urine test called Immunological test , add anti HCG (from rabbit or sheep which has been immunize against HCG) to maternal urine then add an indicator (HCG coated latex particle OR HCG coated RBC cell ). • If no pregnancy the latex particle ppt. or RBC cell agglutinate .

  25. Pregnancy Testing • Maternal serum test(Radioimmunoassay) • Detect HCG B subunit specifically . • Dx within 9-12 day after conception . • B subunit is more accurate ,because anti α HCG may cross react with LH and give false positive result .

  26. Diagnosis of Early Pregnancy • Other tests • Progesterone test • Cervical mucus examination • Basal body temperature (BBT)

  27. Diagnosis of mid or late pregnancy • Symptoms and signs • EDC: +9 or –3 (month), +7 (day) • Enlargement of uterus • 12th week: 2 finger above the symphysis • 16th week: midway between the symphysis and the umbilicus. • 20th – 22nd week: at the umbilicus • …….

  28. 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 .

  29. Diagnosis of mid or late pregnancy • Fetal heart tones • Heared: the 18th – 20th weeks • Normal rate: 120-160bpm • Differentiation: uterine souffle (increased blood flow to uterus ,stethoscope pass firmily against uterine wall , hear blowing murmur synchronizes with maternal pulsation . • This hear after 20 week .

  30. Fetal body • Palpated: outlines of the fetus (the 20th week).

  31. Diagnosis of mid or late pregnancy • Fetal body Palpated: outlines of the fetus (the 20th week).

  32. END

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