Diagnosis of Pregnancy for nursing students.pptx

Lecture materials on obstetrics

1. Diagnosis of pregnancy Pregnancy Diagnosis 1

2. Diagnosis of Pregnancy A. Presumptive symptoms Amenorrhea. Because ovulation can be late in any given cycle, the menses should be at least 10 days late before their absence is considered a reliable indication. Breast changes Breast enlargement and nodularity are evident as early as the second month of pregnancy . The nipples and areolae enlarge and become more deeply pigmented. 2

3. Diagnosis of Pre g...ctd Nausea (with or without vomiting). The so-called morning sickness of pregnancy usually begins early in the day . Gastrointestinal disturbances begin at 4 to 6 weeks' gestation and usually last no longer than the first trimester. Excessive nausea and vomiting (i.e., hyperemesis gravidarum ) can result in dehydration, weight loss and electrolyte imbalance . Disturbances in urination. Early in pregnancy, the enlarging uterus puts pressure on the bladder, causing frequent urination. This condition improves as the uterus grows and moves up into the abdomen . 3

4. Diagnosis of Pre g...ctd Fatigue. Tiredness is one of the earliest symptoms of pregnancy. Fatigue usually persists into the second trimester; the need for sleep returns to normal by the 16th to 18th week . Sensation of fetal movement. Between the 16th and 20th week after the last menstrual period (LMP), a woman begins to feel movement in the lower abdomen, described as a fluttering or gas bubbles. This is known as quickening. 4

5. Diagnosis of Pre g...ctd B. Clinical evidence/probable signs Enlargement of the abdomen By the end of the 12th week of pregnancy, the uterus can be felt above the symphysis pubis . By the 24th week, the uterus should be at the level of the umbilicus. Between the 20th week and the 37th week, the fundal height in centimeters should correspond, within 2 cm, to the gestational age in weeks . 5

6. Diagnosis of Pre g...ctd Uterine and cervical changes. The uterus enlarges and softens early in pregnancy (at approximately 6 weeks' gestation), and lateral uterine vessel pulsations are palpable on vaginal examination. The softening between the cervix and the uterine fundus causes a sensation of separateness between these two structures ( Hegar sign). The vaginal mucosa has a bluish color within the first 6 to 8 weeks of pregnancy (Chadwick sign). 6

7. Diagnosis of Pre g...ctd Endocrine tests for pregnancy These tests depend on human chorionic gonadotropin ( hCG ) levels in maternal plasma and excretion of hCG in the urine. The presence of hCG can be demonstrated in maternal plasma by 8 to 9 days after ovulation. Urine pregnancy tests detect the presence of hCG . Serum pregnancy tests detect the presence and quantify the β subunit of hCG . The serum test is more sensitive than the urine test 7

8. Diagnosis of Pre g...ctd C. Confirming the diagnosis of pregnancy Identification of a heartbeat. The diagnosis of pregnancy is confirmed with the identification of the fetal heartbeat, which ranges from 120 to 160 beats per minute. The fetal heart can be identified by the 10th week with an ultrasonic fetal heart Doppler monitor and at 17 to 19 weeks by auscultation with a stethoscope. 8

9. Diagnosis of Pre g...ctd Ultrasonographic recognition of the fetus After 5 weeks of amenorrhea, an early chorionic (gestational) sac is visible using ultrasound. The embryo is apparent within the gestational sac after 6 weeks of amenorrhea Fetal heart activity is seen by real-time ultrasonography after 6 weeks of gestation. The normal heart rate maybe as low as 90 beats per minute at 6 weeks and increases during the first trimester. 9