Diagnosis of pregnancy SEMINAR.pptx kjgjhfgvhghghgc

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1. Diagnosis of pregnancy Dr. SANA ALAM

2. PREGNANCY OCCURS DURING REPRODUCTIVE PERIOD (15-44 YRS ) OF WOMAN. MEAN DURATION OF PREGNANCY, Also known as - GESTATIONAL AGE , From the first day of the last menstrual period TO:- 9 MONTHS AND 7 DAYS or 280 DAYS or 40 WEEKS

3. TRIMESTERS FIRST TRIMESTER - 1ST 14 weeks SECOND TRIMESTER – 14 week +1day - 28 weeks THIRD TRIMESTER >- 28 weeks +1day - 42 weeks

4. DIAGNOSIS OF PREGNANCY IS IMPORTANT : To assure couple To prevent exposure To start antenatal check-up Diagnosis begins when – wom a n miss es her periods / positive urine pregnancy test

5. SYMPTOMS:- 1.Amenorrhea (missed periods) Earliest symptom due to increased estrogen and progesterone production by the corpus Luteum. Slight bleeding at the expected time of menstruation rarely occurs in the first 3 months (Hartman's sign / Placental sign) Shouldn’t get confused with Threatened abortion. Diagnosis in the first trimester (first 14 weeks)

6. 2 Morning sickness: 50% cases - usually appears around 6 weeks Is because of hormone beta- hCG Nausea, vomiting especially in the morning on rising from the bed. Usually disappears after the third month.

7. 3 FREQUENCY OF MICTURITION Due to congestion of bladder mucosa. Can also be due to high progesterone levels resting of bulky uterus on the bladder (anteverted position of the uterus). change in maternal osmoregulation > leads to increased thirst and polyuria. Usually disappears after the third month.

8. 4- Breast symptoms : Enlargement, heaviness, discomfort and pricking sensation - 6th - 8th week specially in primigravidae. 5 Appetite changes : Craving for certain types of food and refusal of other types. 6- Fatigue : frequent symptom that may occur in pregnancy and tendency to sleep

9. Objective sign 1 Breast signs (evident in a primigravida). 6 - 8 weeks Increased size and vascularity - Dilated visible veins in breasts . Increased pigmentation of the nipple and primary areola. Appearance of secondary areola. Appearance of Montgomery tubercles in the areola (dilated sebaceous glands).

10. UTERUS: Uterus remains a pelvic organ until 12th week , it may be just felt per abdomen as suprapubic bulge therefore no appreciable sign are seen in first trimester. 3 . Pelvic changes – JACQUEMIER'S OR CHADWICK'S SIGN OSIANDER'S SIGN GOODELL'S SIGN

11. JACQUEMIER'S SIGN Also known as Chadwick's sign Dusky hue of the vestibule and anterior vaginal wall visible at 8th week More pronounced as pregnancy advances and is more definitely present in multipara. Due to local vascular congestion.

12. OSIANDER'S SIGN Increased pulsation, felt through the lateral fornices  at 8th week.

13. GOODELL'S SIGN Cervix becomes soft as early as 6th week Softening is more surrounding the external os and also in the upper part. Cervix usually has consistency like the nose(firm) while in pregnancy cervix has consistency like lips (soft).

14. 4. Uterine sign :- felt by bimanual examination Size : enlarged. consistency : soft. Shape : globular Hegar sign : (elicited between 6-10 weeks).Two fingers in the anterior fornix, the fingers of the other hand over the abdomen behind the uterus. The fingers of both hands can be approximated as the lower part of the uterine body is soft and empty. Palmer sign : Uterine contractions felt on bimanual examination

15. IMMUNOLOGICAL TESTS HCG- It can be detected either in maternal urine or in blood. 1. HCG in maternal urine This hormone is only released by trophoblastic tissue produced by a growing fetus and its associated placenta HCG is present in the maternal circulation as either an intact dimer, alpha or beta subunit, and degraded form, or beta core fragment Diagnostic levels in Urine seen only about 23-24 days after conception.

16. 2.HCG in blood 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 Levels peak at 10-12 weeks gestation and then plateau before falling

17. Blood tests for HCG- Require special labs and expertise Currently, 4 main HCG assays are used, Radioimmunoassay immunoradiometric assay enzyme-linked immunosorbent assay (ELISA), Fluoro -immunoassay.

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

19. LEVEL 1 SCAN : (nuchal translucency scan) Done between 11-14 weeks of pregnancy Helps to determine fetus’s risk of having down syndrome and chromosomal abnormalities

20. Symptoms: Amenorrhea persists. Morning sickness and urinary symptoms gradually decrease. "Quickening " : perception of fetal movements by the pregnant woman a. 18-20 weeks in primigravida b.16-18 weeks in multipara. 4.abdominal enlargement DIAGNOSIS IN THE SECOND TRIMESTER (14WEEK 1 DAY -28 WEEKS)

21. ABDOMINAL EXAMINATION . Inspection: Linea nigra extending from symphysis pubis to xiphisternum  --20th week.

22. STRIAE ( pink ,purple and white) visible in the lower abdomen more towards the flanks...

23. PALPATION:- Fundal height – increased with progressive enlargement of the uterus.

24. The uterus is abdominally felt (ovoid). The uterus feels soft and elastic Braxton Hicks contractions : intermittent painless contractions detected by abdominal examination. Active fetal movements can be felt at intervals by placing the hand over the uterus as early as 20th week. External ballottement : elicited at 20 week through abdominal examination. Palpation of the fetal parts and palpation of fetal movements by the obstetrician at 20 weeks.

25. 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

26. INVESTIGATIONS.. SONOGRAPHY : - Routine sonography at 18- 20 weeks permits a detailed survey of fetal anatomy, placental localisation and the integrity of the cervical canal. FETAL ORGAN ANATOMY :- To detect any malformation. FETAL VIABILITY

27. Level 2 scan : (anomaly scan) Done between 18-22 weeks of pregnancy Helps in – Measuring your baby's size and checking all major organs Screening for some genetic disorders

28. SYMPTOMS:- Amenorrhea persists Enlargement of the abdomen due to increased fundal height  leading to discomfort to the patient due to increased compression of diaphragm, ( palpitaion 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 Perception of Fetal movements are more pronounced. Diagnosis in the third trimester (28 week 1 day – 42 weeks)

29. SIGNS:- Cutaneous changes are more prominent with increased pigmentation and striae Uterine shape - from cylindrical to spherical beyond 36th week FUNDAL HEIGHT ( between the umbilicus and xiphisternum ) • corresponds to Junction of the upper and middle third at 32 weeks • Level of xiphisternum at 36th week • Comes down to 32 wee k level at 40th week because of the engagement of the presenting part. (if the head is floating,it is of 32 weeks pregnancy and if the head is engaged it is 40 weeks of pregnancy)

30. • SYMPHYSIS FUNDAL HEIGHT (SFH) - 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 upto the point marked is measured in cm. After 24 weeks, the SFH in cm corresponds to the number of weeks upto 36 weeks Braxon -Hicks contraction - more evident Fetal movements  -  easily felt

31. Palpation of the fetal parts and their identification become much easier F.H.S - heard distinctly SONOGRAPHY :- Fetal growth assessment can be made more accurate Amniotic fluid volume assessment.

32. DIFFERENTIAL DIAGNOSIS UTERINE FIBROID CYSTIC OVARIAN TUMOUR (Amenorrhoea absen tfirm , hard, positive sign absent, USG) ENCYSTED TUBERCULAR PERITONITIS (H/O Koch'sinfection , swelling il defined, positive signs absent, USG) HAEMATOMETRA DISTENDED URINARY BLADDER (Catheterisation solves the problem)  PSEUDOCYESIS

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