Diagnosis of pregnancy

DIAGNOSIS OF PREGNANCY

1. DIAGNOSIS OF PREGNANCY

2. INTRODUCTION The diagnosis of pregnancy traditionally has been made from history and physical examination. Important aspects of the menstrual history must be obtained. The woman should describe her usual menstrual pattern, including date of onset of last menses, duration, flow, and frequency

3. TERMINOLOGY Amniotic sac Braxton Hicks Contractions Conception Fetus Gestation Placenta Trimesters Ultrasound

4. MENSTRUAL AGE

5. Also known gestational age . From the first day of the last menstrual period… 9 months and 7 days 280 days 40 weeks

6. TRIMESTER

7. DIAGNOSIS OF 1 ST TRIMESTER

8. SUBJECTIVE SIGN

9. OBJECTIVE SIGN

10. IMMUNIOLOGICAL TEST

11. HCG( HUMAN CHORIONIC GONODOTROPIN)

12. Detection of HCG in maternal serum and urine is evident only 8- 10 days after conception HCG is detectable in the serum of approximately 5% of patients 8 days after conception and in more than 98% of patients by day 11 Diagnostic levels in Urine seen only about 23-24 days after conception. Levels peak at 10-12 weeks' gestation and then plateau before falling

13. BLOOD TEST FOR HCG

14. 4 main H CG assays are used ( 1) radioimmunoassay (2) immunoradiometric assay (3) enzyme-linked immunosorbent assay (ELISA) (4) fluoro immunoassay.

15. ULTRASOUND

16. Intra decidual gestational sac is identified as early as 29 – 35 days of gestation Gestational sac & yolk sac -5 menstrual weeks Fetal pole and cardiac activity – 6 weeks Embryonic movements -7 weeks Doppler effect of USG can pick heart rate reliably by 10th week.

17. DIAGNOSIS IN THE SECOND TRIMESTER ( 13-28 WEEKS)

18. ABDOMINAL EXAMINATION INSPECTION : – Linea nigra extending from symphysis pubis to ensiform cartilage  20th week… STRIAE ( both pink and white) visible in the lower abdomen more towards the flanks PALPATION: – Fundal height – increased with progressive enlargement of the uterus.

19. Auscultation Auscultation of FHS as early as 20-24 weeks by Pinard stethoscope Auscultation of funic/ fetal souffle due to rush of blood through the umbilical artery Auscultation of uterine souffle (soft blowing and systolic murmur heard low own at the sides of the uterus) synchronous with the maternal pulse

20. INVESTIGATIONS SONOGRAPHY : – Routine sonography at 18 – 20 weeks permits a detailed survey of fetal anatomy, placental localisation and the integrity of the cervical canal. RADIOLOGIC : – 16TH WEEK – FETAL SKELETAL SHADOW.

21. DIAGNOSIS IN THE THIRD TRIMESTER (29 - 40WEEKS)

22. AMENORRHOEA PERSISTS – Enlargement of the abdomen leading to discomfort to the patient (palpitation or dyspnoea following exertion) LIGHTENING: 38th week sense of relief of the pressure symptoms due to engagement of the presenting part. Frequency of micturition reappears – Fetal movements are more pronounced. SIGNS: – Cutaneous changes are more prominent with increased pigmentation and striae. Uterine shape – from cylindrical to spherical beyond 36th week

23. FUNDAL HEIGHT (distance between the umbilicus and ensiform cartilage) Junction of the upper and middle third at 32 weeks. Level of ensiform cartilage at 36th week Comes down to 32 week level at 40th week because of the engagement of the presenting part.  

24. SYMPHYSIS FUNDAL HEIGHT – Upper border of the fundus located by ulnar border of the left hand and point is marked. – Distance between the upper border of the symphysis pubis up to the point marked is measured in centimetre

25. SIGNS OF PREVIOUS CHILD BIRTH Breast become more flabby Abdominal wall is more lax and loose. There may be presence of silvery white striae and linea alba. Uterine wall is less rigid and the contour of the uterus is broad and round, rather than ovoid.

26. Perineum is lax and evidence of old scarring from previous perineal laceration or episiotomy may be found Vagina is more roomy. Cervix: Nulliparous cervix is conical with a round external os . In parous women, it becomes cylindrical

27. ESTIMATION OF GESTATIONAL AGE AND PREDICTION OF EXPECTED DATE OF DELIVERY(EDD) Gestational age is about 280 days calculated from the first day of the last normal menstrual period (LMP). Accurate LMP is the most reliable parameter for estimation of gestational age.

28. PATIENT'S STATEMENT Date of fruitful coitus Naegele's formula Date of quickening

29.   INVESTIGATIONS Sonography-The following parameters are of use.   First trimester - CRL is most accurate (variation± 5 days). To add 30 weeks since the documentation of fetal heart tones by Doppler USG.

30. Second trimester by BPD, HC, AC and FL measurement. Most accurate when done between 12 and 20 weeks (variation ± 8 days). To add 20 weeks since the measurement of fetal parameters for anomaly scan (18-20 weeks). Third trimester -less reliable, variation ± 16 days.

31. SUMMARY:- Today we discuss about diagnosis of pregnancy according their trimester. We also discuss about differential diagnosis, previous birth sign, expected date of delivery.   CONCLUSION The diagnosis of pregnancy can be made by several methods. Normocyclic women who present with amenorrhea and typical history and physical exam findings have the classic presentation and can be diagnosed with a viable intrauterine pregnancy if they progress appropriately.    

32. RESEARCH ABSTRACT   Objective:  The aim of this study was to analyse the characteristics of the prenatal diagnosis (PD) of birth defects (BDs) and termination of pregnancy (TOP) for fetal anomalies and to suggest perinatal management. Methods:  BD surveillance data were collected from 52 registered hospitals in Hunan between 2015 and 2018. The PD and TOP rates of BDs were calculated to examine the associations between infant sex, maternal age, and region.

33. Results:  From 2015 to 2018, a total of 18 931 fetuses with BDs were identified, of which 10 299 fetuses (54.4%) were diagnosed prenatally and 9343 pregnancies (90.7% among PDs and 49.3% among BDs) were terminated. The mean gestational age at diagnosis for fetuses with BDs was 25.1 ± 5.9 weeks and showed a downward trend over the study period. The average PD rate of the BDs was higher in rural areas than in urban areas (58.1% vs 50.3%), higher for female than male fetuses (57.25% vs 48.92%), and higher for mothers older than age 35 than for those younger (58.62% vs 53.69%).

34. The average TOP rate of fetuses with BDs in rural areas was higher than that in urban areas (91.99% vs 89.12%) and decreased with increasing maternal age ( x2trendxtrend2 = 7.926, P = .005). The five BDs with the highest PD rates were conjoined twins (100%), anencephaly (97.87%), congenital hydrocephalus (97.66%), chromosomal malformation (96.07%), and encephalocele (95.54%). The five BDs with the highest TOP rates among the PDs were conjoined twins (100%), exstrophy of the urinary bladder (100%), chromosomal malformation (98.09%), encephalocele (98%), and anencephaly (97.28%).

35. Conclusions:  More than half of BDs were diagnosed prenatally, with the majority diagnosed at less than 28 gestational weeks. The TOP rates following PD in Hunan Province were high, especially for rural and younger mothers. The findings suggest a need for high-quality, targeted counselling following PD. Conducted On: 10 June 2020