diagnosis of pregnancy liu wei department of ob & gy ren ji hospital

Diagnosis of Pregnancy

Liu Wei

Department of Ob & Gy

Ren Ji hospital

Diagnosis of Early Pregnancy

• History and symptoms

1. Amenorrhea

1) The first and the most important symptom

2) Note 1: emotional tension, chronic disease and certain medications → delayed menses

3) Note 2: lactation, IUD and dysfunction of endocrine → pregnancy

Diagnosis of Early Pregnancy

2. Morning sickness

1) Fatigue, swirling, nausea and vomiting (the 6th week↑ → the 12th week↓ ).

2) Hyperemesis gravidarum (妊娠剧吐 ): protracted vomiting necessitating hospitalization.

3) Causes: HCG, delayed gastric emptying(P↑ )

Diagnosis of Early Pregnancy

3. Urinary symptoms

1) Bladder irritability, frequency and nocturia

2) Causes: increased circulation in pelvis (E and P↑), enlargement of the uterus.

3) Note: urinary infection must be ruled out

Diagnosis of Early Pregnancy

4. Mastodynia (乳房胀痛 )

1) the development of mammary ducts (E↑) and alveolar system (P↑)

2) circulation↑→ engorgement of the breasts

5. Constipation (便秘 )

smooth muscle relaxant (P↑)

6. Weight gain

Diagnosis of Early Pregnancy

• Signs1. The changes of genital organs1) Vagina: bluish or purple discoloration (congested

pelvic vasculature). Increased vaginal discharge (E and P↑)

2) Cevix: softening and bluish discoloration. The cervical mucus→ a granular pattern

3) Uterocervical junctionHegar’s sign: a widened zone of softness coupled with

compressibility, resulting in a doughnut-shaped, slightly spongy configuration.

Hegar’s sign

Diagnosis of Early Pregnancy

4) Abdominal enlargement Enlargement of uterus (noticed at the 12th

week)2. Breast changes1) Enlargement and vascular engorgement (6th –

8th week)2) Montgomery’s tubercles (蒙氏结节 ): 6th –8th

week, E and P↑3) Colostrum secretion (16th week) or secondary

breasts

Diagnosis of Early Pregnancy

• Laboratory tests

1. Pregnancy test

1) Urine HCG test (one step): + or –

2) β-HCG: >25mIU/L

2. Ultrasonography

1) Enlargement of uterus

2) Gestational sac

3) Embryo or fetal pulse

Diagnosis of Early Pregnancy

3. Other tests

1) Progesterone test

2) Cervical mucus examination

3) Basal body temperature (BBT)

Diagnosis of mid or late pregnancy

• Symptoms and signs

1. EDC: +9 or –3 (month), +7 (day)

2. Enlargement of uterus

1) 12th week: 2 finger above the symphysis

2) 16th week: midway between the symphysis and the umbilicus.

3) 20th – 22nd week: at the umbilicus

4) …….

Diagnosis of mid or late pregnancy

3. Fetal movement (FM)

1) The first perception: in the 18th – 20th weeks

2) Diagnosis of pregnancy, duration of pregnancy, the safety of fetus

3) Count: 3 times per day, 1 hour per time. sum×4= FM/12 hours. Normal:≥ 30/12 hours

Diagnosis of mid or late pregnancy

4. Fetal heart tones

1) Heared: the 18th – 20th weeks

2) Normal rate: 120-160bpm

3) Differentiation: umbilical souffle (脐带杂音 )

5. Fetal body

Palpated: outlines of the fetus (the 20th week).

Diagnosis of mid or late pregnancy

• Laboratory tests1. Ultrasonography1) The number of fetus2) Fetal lie3) Fetal presentation4) Fetal position5) Fetal dead or not 6) Placenta and cord (velocity of flow)7) Size of fetus

Diagnosis of mid or late pregnancy

2. Fetal electrocardiography, FECG

12th week

Fetal Attitude

• Fetal lie Refers to the relationship of the long axis of

the fetus to the long axis of the mother1. Longitudinal lie The long axis of the fetus is parallel with that

of the mother2. Transverse lie The long axis of the fetus crosses that of the

mother vertically

Fetal lie

Fetal Attitude

• Fetal presentation1. head presentation Occiput presentation (95%), brow

presentation and face presentation.2. Breech presentation1) Complete breech presentation2) Frank breech presentation3) Incomplete breech presentation: footling

presentation

Head presentation or breech

Fetal Attitude

• Fetal position Refers to the relationship of the point of direction

of the presenting part to one of the 4 quadrants of the pelvis or to the transverse diameter of the maternal pelvis.

1. Occiput presentation: the occiput, O. LOA,LOT,LOP

2. Face presentation: the chin, M. LMA,LMT,LMP3. Breech presentation: the sacrum,

S.LSA,LST,LSP

Fetal position

END