DIAGNOSIS OF PREGNANCY

PRESENTED BY : MS. VRUTI PATEL,F.Y.M.SC. NURSING,SCN

INTRODUCTION

Presumptive signs Probable signsPositive signs

DIAGNOSIS THE PREGNANCY

In first trimesterIn second trimesterIn third trimester

FIRST TRIMESTER (FIRST 12 WEEKS)

Subjective Sentence Amenorrhoea – Abrupt cessation of

menstruation at 4th week Morning sickness (Nausea and vomiting) from

4th – 14th week Frequency of micturition (Bladder irritability Breast discomfort Fatigue

Objective sign• Breast changes - valuable only in primigravidae • Per abdomen • Pelvic changes• Jacquemier’s or chadwick’s sign• Vaginal sign• Cervical signs - as early as 6th week (Goodell’s

sign)• Uterine signs : (a) Size, shape and consistency

(b) Hegar’s sign

(c) Palmer’s sign

IMMUNOLOGICAL TESTS FOR DIAGNOSIS OF PREGNANCY

• Principle : Pregnancy tests depend on detection of the antigen (hCG) present in the maternal urine or serum with antibody either polyclonal or monoclonal available commercially.

(A) Immuno assays without radioisotopes

•Agglutination inhibition tests – Using latex (L.A.I.)

•Principle of agglutination inhibition tests

•Direct agglutination test (hCG direct test)

•Enzyme-linked immunosorbent assay (ELISA

•Fluoroimmuno assay (FIA)

(B) Immuno assay with radiosotopes•Radioimmunossay (RIA) - used for determining the doubling time of hCG (ectopic pregnancy monitoring)

•Immuno-radiometric assay (IRMA) - detect hCG as low as 0.05 mIU/ml

Selection of time

Collection of urine

Other uses of pregnancy tests

Ultrasonography

SECOND TRIMESTER (13-28 WEEKS)

Symptoms :• subjective symptoms –such as nausea,

vomiting and frequency of micturition usually subside

• Quickening (feeling of life)

• Progressive enlargement of the lower abdomen

General Examinationo Chloasma : Pigmentation over the forehead and

cheek

o Breast changes - enlarged with prominent veins, Secondary areola, Montgomery’s tubercles are prominent and extended, Colostrum

o Abdominal examination• Inspection

• Palpation• Auscultation - Uterine souffle - soft blowing and

systolic murmur heard low down at the sides of the uterus, best on the left side; Funic of fetal soufflé is due to rush of blood through the umbilical arteries

o Vaginal Examination• The bluish discolouration• Internal ballottement

o Investigations• Sonography• Fetal organ anatomy• Magnetic Resonance Imaging (MRI

LAST TRIMESTER (29-40 WEEKS)

Symptoms

(1) Amenorrhoea persists

(2) Enlargement of the abdomen is progressive

(3) Lightening – At about 38th week

(4) Frequency of micturition

(5) Fetal movements

SIGNS

• Cutaneous changes

more prominent with increased pigmentation and striae

• Uterine shape

changed from cylindrical to spherical beyond 36th week.

• Fundal height • Symphysis fundal height (SFH) The upper border of the fundus is located by the ulnar border of the left hand and this point is marked

• Braxton-Hicks contractions are more evident.

• Fetal movements are easily felt

• Palpation of the fetal parts

• FHS

• Sonography

DIFFERENTIAL DIAGNOSIS

• Uterine Fibroid,

• Cystic Ovarian Tumour,

• Encysted Tubercular Peritonitis, Haematomata

• Even Distended Urinary Bladder, etc.