The Diagnosis of Pregnancy

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The Diagnosis of Pregnancy

• Zhang Qingxue
• Departmentment of ob gyn
• Sun yat-sen memorial hospital
• Sun yat-sen university

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The Whole Period of Pregnancy Can Be Divided Into
Three Stages

• The first trimester (early pregnancy) 1-12w
• The second trimester (middle pregnancy) 13-27 w
• The third trimester (late pregnancy) 28-40w

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The Diagnosis of the First Trimester

• 1.History and symptoms
• A. Cessation of menstruation
• This is the first frequent symptom of
  pregnancy, although a few women may have slight
  bleeding after conception. But amenorrhea is not
  only due to pregnancy but also other reasons.
  Women of breast feeding may be pregnant before
  the recovery of menses.

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1.The history and symptoms

• B. Nausea and vomiting
• Also called morning sickness because they occur
  upon arising. These symptoms appear one or two
  weeks after the period is missed and last until
  10th to 12th week, its severity varies from mild
  nausea to persistent vomiting (e.g. Hyperemesis
  gravidarum).

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1.The history and symptoms

• C. Urinary symptoms
• Increased frequency of urination is due to
  increased circulation associated with the effect
  of estrogen and progesterone on the bladder,
  combined with pressure by the gradually enlarged
  uterus on the bladder.

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Internal genital organs
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1.The history and symptoms

• D. Mastodynia
• It may be present in early pregnancy and
  ranges in severity from a tingling sensation to
  frank pain.

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2. Signs

• Breast changes
• Breast enlargement and vascular engorgement.
  Nipple and areola become blacker. Enlargement of
  the accumulated sebaceous glands of the areolas
  (Montgomerys tubercles) may be noted.

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Fig.20-1 Breast changes. Montgomerys glands are
prominent, and nipples and areolae are deeply
pigmented. Accessory nipple beneath left breast
is also pigmented.
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Changes of the reproductive organs

• Vagina The vaginal wall become discoloration as
  the pelvic blood vessel becomes congested.
• Cervix Cyanosis and a gradual softening due to
  congestion.

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Changes of the reproductive organs

• Uterus enlargement and softening. The isthmus of
  the uterus is also soft and can be compressed
  between the fingers palpating vagina and abdomen
  (Hegars sign). After the 12th week, the fundus
  of the uterus is usually palpable above the
  symphysis pubis.

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C. Supplementary examination

• Pregnancy test
• The laboratory test for pregnancy are based on
  the identification of human chorionic
  gonadotropin (hCG), which can be detected as
  early as 7-9 days after fertilization by high
  sensitive technique. The samples may be blood or
  urine.

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Pregnancy test
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Basal body temperature (BBT)

• A persistent elevation of BBT for longer than
  18 days may be presumptive evidence of pregnancy.

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Progesterone test

• Progesterone is given to a women with
  amenorrhea. If she is pregnant, no bleeding will
  follow, otherwise, bleeding should occur within
  7-10 days of progesterone administration. This is
  reliable in the nonpregnant patient only if there
  is adequate estrogen stimulation of the
  endometrium.

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cervical mucus

• The cervical mucus smear of pregnant women shows
  a progestational effectthat is ellipsoid instead
  of fern crystallization.

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cervical mucous (1) type? () typical
fern crystallization (2) type? () fern
crystallization (3) type ?() atypical fern
crystallization (4) type ? (-) ellipsoid
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Ultrasonography

• There are trans-vaginal and abdominal
  Ultrasonagraphys.
• A gestational sac can usually be identified at
  5-6 weeks after the beginning of the last period.

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Ultrasonography

• Fetal heart beating can be detected by about 7th
  week and the fetus itself can be seen by about
  the 8th week.
• Doppler is also an ultrasound technique, which
  diagnoses the pregnancy by revealing the heart
  beating.

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Picture of gestational sac
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Picture of normal fetus a.Pregnancy of
8wb.Pregnancy of 18w BL-bladderUT-uterusGS-gest
ational sac
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The diagnosis of the second and the third
trimester pregnancy

• Symptoms
• Abdominal enlargement and fetal movement
  generally occurs after the 18th to 20th week of
  gestation.

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Signs

• The uterus continues to enlarge
• Fetal movement (quickening) can usually be seen
  or heard after 18th week of gestation

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Height of the uterine top
xiphoid
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Signs

• Fetal heart sound can be heard at rate varies
  from 120 to 160 beats per minute.
• The fetal body can usually be palpated by the
  18th to 20th week of gestation unless the patient
  is too fat, the abdomen is tender or there is an
  excessive amount of amniotic fluid.

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Fetal heart
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Fetal heart
(uterine souffle and umbilical souffle)
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ballottement
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Other Examinations

• Ultrasonography.
• X-ray. It is rarely used recently because the
  harmfulness to the fetus.
• Fetal electrocardiogram. A fetal
  electrocardiogram can first be recorded at about
  the 12th week of pregnancy.

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Different methods of pregnancy diagnosis
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Fetal lie fetal Presentation

• Fetal lie the relationship between the long axis
  of the mother and the long axis of the fetus.
  (longitudinal lie and transverse lie)
• Fetal presentation the portion of the fetus that
  descends into pelvis first.

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fetal position

• Fetal position the relationship of some guiding
  point of fetal presentation to a fined area of
  the maternal pelvis. (LOA, left occipital
  anterior)

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Thank you !