daignosing and dating pregnancy in midwifery

dating pregnancy

1. DIAGNOSIS AND DATING OF PREGNANCY V.KHONJE

2. OBJECTIVES By the end of the lesson , students should be able to: Understand the various ways of diagnosing and dating pregnancy Accurately diagnose and date pregnancy

3. Introduction Diagnosis of pregnancy is based on physiological changes that occur in the body of the pregnant woman Most women visit the ANC suspecting to be pregnant and requires the midwife to confirm their suspicion Those women in remote areas depend on tradition ways to diagnose pregnancy because of Understanding the physiological changes is essential for midwives to accurately diagnose and date pregnancy

4. Ways to diagnose pregnancy Presumptive (subjective) signs and symptoms Probable ( objective) signs of pregnancy Positive signs of pregnancy

5. Presumptive signs and symptoms Amenorrhea - Pregnancy is the most common cause however it can also be present in Stress and environment Endocrine disorders Medical condition Morning sickness Common in 50% of women from 4 th to 14 th week of pregnancy Should be mild if excessive is hyperemesis graviduram Can also be present in gastritis , hepatitis and other infections

6. Presumptive signs and symptoms Bladder irritability Frequency of micturition without any signs of infections Occurs between 8 th and 14 th week of pregnancy Probably caused by increased blood volume- increased renal blood flow and glomerular filtration rate Pressure from enlarging uterus

7. Presumptive signs and symptoms Breast changes

8. Appetite changes Fatique Quickening

9. Probable ( objective) signs of pregnancy Jacquenier’s sign Osiander’s sign Goodell’s sign Quickening

10. Pregnancy trimesters First trimester: 1 – 12weeks Second trimester: 13-28weeks Third trimester: 29 – 40 weeks

11. DIAGNOSIS OF PREGNANCY

12. First trimester Symptoms Cessation of menstrual period - due to increased oestrogen production by the corpus luteum Morning sickness – usually appears soon after missed period - Usually disappears after 3 rd month Frequency of micturition – due to congestion of bladder mucosa, irritation of bladder by pregnant uterus Resting of bulky uterus on the bladder (anteverted position) Change of maternal osmoregulation leads to increased thirst and polyuria

13. Breast symptoms – enlargement, heaviness, discomfort and pricking sensation Appetite changes – craving of certain foods (Pica) and refusal of other foods Fatique

14. Skin pigmentation due to increased melanocyte stimulating hormone (chloasma)

15. Breast signs Increased size and vascularity, dilated visible veins Increased pigmentation of the nipple and primary and secondary areola Appearance of Montgomery tubercles in the areola (dilated sebaceous gland) Expression of colostrum (thick yellow secretion)

16. ABDOMEN Uterus remain pelvic organ until 12 th week PELVIC CHANGES Jacquemier’s / Chadwick’s sign –bluish or purplish colouration of the vagina and cervix) Osiander’s sign – increased pulsation, felt through lateral fornices at 8 th week Goodell’s signs – cervix becomes soft due to increased vascularization - pregnant cervix feels like lips of the mouth (non pregnant cervix feels like tip of the nose) - on speculum examination, bluish discolouration of the cervix due to increased vascularity

17. UTERINE SIGNS Size – enlarged Consistency – soft Shape – globular Palmar sign – uterine contractions felt on examination

18. Hegar’s sign (between 2-10 weeks) - two fingers in the anterior fornix, the fingers of the other hand over the abdomen behind the uterus. Fingers of both hands can be approximated as the lower part of the uterine body is soft and empty

19. Other tests HCG - available in maternal serum and urine (8 – 10 days after conception) USS – gestation and yolk sac seen at 5 weeks gestation - fetal poles seen at 6 weeks - embryonic movements seen at 7 weeks - fetal heart rate seen at 10 weeks

20. SECOND TRIMESTER Amenorrhoea Morning sickness Quickening – perception of fetal movements by pregnant woman - primgravida : 18-20 weeks - multigravida: 16 – 18 weeks Abdominal enlargement

21. ABDOMINAL EXAMINATION INSPECTION Striae – visible in the lower abdomen towards the flanks Linia nigra is more prominent

22. PALPATION - Fundal height increases with progressive enlargement of the uterus Uterus is felt ovoid, feels soft and elastic Brackston hicks contractions – intermittently painless Active fetal movements felt at intervals by placing the hand over the uterus as early as 20 th week External ballotment : elicited at 20 weeks Palpation of fetal parts and palpation of fetal movements at 20 weeks

23. THIRD TRIMESTER Amenorrhoea persist Enlargement of the abdomen Lightening at 38 weeks – sense of relief of the pressure symptomsdue to engangement of the presenting part Frequency of micturition reappears Fetal movements are more pronounced Uterine shape- spherical beyond 36 weeks Braxton hicks contractions more evident Fetal movements easily felt Palpation of fetal parts and their identification becomes much easier Fetal heart sound auscaltated

24. PRESUMPTIVE SIGNS Amenorrhoea Morning sickness Frequency of micturition Breast enlargement Appetite changes fatique PROBABLE SIGNS Jacquenier’s sign Osiander’s sign Goodell’s sign Quickening POSITIVE SIGNS PT (HCG) USS Positive fetal heart sounds

25. DATING OF PREGNACY

26. NAGELE’S RULE ct … If LNMP: from January to March LNMP plus 7 days plus 9 plus 0 ( ? No BODMAS) LNMP +7 + 9 months + 0 (will deliver the same year) Example: LNMP is 10 th February, 2020 EDD is : 10. 02.2020 +7 + 9 +0 ------------------ 17. 11. 2020 -------------------

27. NAGELE’S RULE ct … If LNMP: from April to December LNMP plus 7 days minus 3 plus 1 ( ? No BODMAS) LNMP +7 - 3 months + 1 Example: LNMP is 14 th June, 2020 EDD is : 14. 06.2020 +7 -3 +1 ------------------ 21. 03. 2021 -------------------

28. GESTATION BY DATES Know LNMP Calculate from LNMP to date Gestation age to be in weeks (however, can use days or weeks in calculation) Exercise: E.g Mrs. X reports for antenatal on 9 th November, 2020. her LNMP is 14 th June, 2020 Calculate EDD Calculate gestation age

29. 2. fundal height Measured on the anterior wall of the abdomen with finger breadth Or Using tape measure and multiply by 8 and divide by 7 (McDonalds rule) e.g 25cm x8/7 = 28.6 weeks =29 weeks FH provides good estimation Helps in identifying IUGR, Multiple gestation, Large for dates

30. 3. USS Accurate (especially in first trimester) Expensive Not available in all health facilities

31. SUMMARY Presumptive, possible and positive signs are used to diagnose pregnacy . Nagele’s rule and fundal height are used to date pregnancy.