Diagnosis of pregnancy

1. DIAGNOSIS OF
PREGNANCY
PRESENTED BY :
MS. VRUTI PATEL,
F.Y.M.SC. NURSING,
SCN

2. INTRODUCTION
Presumptive signs
Probable signs
Positive signs

3. DIAGNOSIS THE PREGNANCY
In first trimester
In second trimester
In third trimester

4. FIRST TRIMESTER (FIRST 12 WEEKS)
Subjective Sentence
Amenorrhoea –Abrupt cessation of
menstruation at 4
th
week
Morning sickness (Nausea and vomiting) from
4
th
–14
th
week
Frequency of micturition (Bladder irritability
Breast discomfort
Fatigue

5. 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 6
th
week (Goodell’s
sign)
•Uterine signs : (a) Size, shape and consistency
(b) Hegar’s sign
(c) Palmer’s sign

6. 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.

7. (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)

8. (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

9. 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

10. General Examination
oChloasma : Pigmentation over the forehead and
cheek
oBreast changes -enlarged with prominent veins,
Secondary areola, Montgomery’s tubercles are
prominent and extended, Colostrum

11. oAbdominal 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

12. oVaginal Examination
•The bluish discolouration
•Internal ballottement

13. oInvestigations
•Sonography
•Fetal organ anatomy
•Magnetic Resonance Imaging (MRI

14. LAST TRIMESTER (29-40 WEEKS)
Symptoms
(1) Amenorrhoea persists
(2) Enlargement of the abdomen is progressive
(3) Lightening –At about 38
th
week
(4) Frequency of micturition
(5) Fetal movements

15. SIGNS
•Cutaneous changes
more prominent with
increased pigmentation
and striae
•Uterine shape
changed from cylindrical
to spherical beyond 36
th
week.

16. •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

17. •Braxton-Hicks
contractions are more
evident.
•Fetal movements are
easily felt

18. •Palpation of the fetal
parts
•FHS

19. •Sonography

20. DIFFERENTIAL DIAGNOSIS
•Uterine Fibroid,
•Cystic Ovarian Tumour,
•Encysted Tubercular Peritonitis,
Haematomata
•Even Distended Urinary Bladder, etc.