Diagnosis of pregnancy for undergraduate

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Diagnosis of pregnancy
DR MANAL BEHERY Zagazig University ,EGYPT
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Principles of diagnosis

• In the majority of women, the diagnosis of
  pregnancy is usually straightforward based on a
  history of amenorrhea and a positive pregnancy
  test.
• women with irregular periods or irregular vaginal
  bleeding , the diagnosis of pregnancy is more
  complex.
• Other symptoms of pregnancy may alert the
  clinician to the possibility of pregnancy.

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Symptoms of pregnancy

• Amenorrhoea HOWEVER
• Pregnancy may occur during period of lactation
  amenorrhea.
• Slight bleeding early in pregnancy (threatened
  abortion) may be considered by the patient as
  menses .
• Hartman's symptoms slight bleeding occurs at
  time of menstruation

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Symptoms of pregnancy

• Morning sickness nausea, rarely vomiting
  confined to morning
• Increased frequency of micturition.
• Enlargement of the breast and sensation of
  heaviness.
• Easy fatiguability and tendency to sleep.
• Emotional changes e.g. change of the appetite

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In the second and third trimesters

• 1-Abdominal enlargement
• 2-Quickening
• -1st perception (sensation) of fetal
  movements by the lady
• -PG (18-20 weeks), MP (16-18 weeks)

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Signs of pregnancy
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Chloasma gravidarum

• Butterfly face
• pigmentation

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Breast signs

• Increased pigmentation of the nipple and lry
  areola.

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Appearance of Montgomery tubercle in the areola

• dilated sebaceous glands

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Abdominal stria
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Linea nigra
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- Abdominal signs Inspection-
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2- Palpation
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Auscultation

• Auscultation of FHS as early as 10-12 weeks by
  sonicade
• Auscultation of FHS as early as 20-24 weeks by
  Pinard stethoscope
• Auscultation of umbilical souffle as early as
  20-24 weeks.
• Auscultation of uterine souffl

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Pregnancy testsPrinciple

• Detection of
• HCG in the
• urine or
• serum .

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1- Urinary pregnancy test

• Classically it becomes Ve 7- 10 day after 1st
  missed period
• Commercial testing kits are available that are
  sensitive to 25 iu/L in urine.
• By the time the mother has missed her first
  menstrual period, her hCG levels are around 100
  iu/L.

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Serum pregnancy test

• Classically it becomes Ve 5- 7 days before 1 st
  missed period
• A quantitative serum HCG assay level of gt 5 iu/L
  will usually denote a pregnancy.
• With a normal intrauterine pregnancy, the hCG
  level doubles approximately every 36-48 hours.

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Tran abdominal US
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Transvaginal ultrasound ( TVS)
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12 WEEKS GESTATION

• CROWN RUMP
• LENGTH(CRL)

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2ND TRIMESTER
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Sure signs of pregnancy

• Inspection of fetal parts as early as 20th week.
• -Inspection of fetal movements as early as
  20th week.
• Palpation of fetal movements as early as 20th
  week.
• -Palpation of fetal parts as early as 20th
  week.

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Sure signs of pregnancy

• -Auscultation of FHS at 10-12 weeks by sonicade
• Investigations Visualization of fetal parts by
  ultrasound

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• Thank you