diagnosis of pregnancy

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A Presentation on 1st and 2nd trimester of diagnosis of pregnany.....

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DIAGNOSIS OF PREGNANCY Vineeta Kumari Final Yr Student M R Medical College

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It can be defined as the condition of having a developing embryo or fetus in the body after successful conception. Calculated in terms of 10 lunar months/ 9 calendar months and 7 days/ 280 days/ 40 weeks. Calculated from 1 st day of last menstrual period Also called MENSTRUAL or GESTATIONAL AGE

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TOPICS TO BE COVERED 1 ST Trimester (first 12 weeks) 2 nd Trimester (13- 28 weeks) 3 rd Trimester (29- 40 weeks) Differential diagnosis of Pregnancy Chronological appearance of specific symptoms and signs in pregnancy Signs of previous birth child Estimation of gestational age and prediction of EDD Estimation of fetal weight

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Duration : 1 st twelve weeks of pregnancy .. Subjective symptoms Amenorrhea Morning sickness Salivation & Changes In Disposition Frequency Of Micturition Breast Discomfort Fatigue

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Absence of menstruation, either as a result of menarche or its absence for more than 3 months in a woman who had previously experienced menstruation &is not pregnant. Highly suggestive of pregnancy in normally menstruating healthy woman. Should be excluded from other conditions such as Anovulation Severe illness Emotional disturbances, etc…..

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Placental sign Cyclic bleeding occurs up to 12 weeks of pregnancy; until the decidual space is obliterated by the fusion of decidua vera with decidua capsularis. This type of bleeding is scanty and for short duration and roughly corresponds with the date of expected period. Should not be confused with threatened abortion.

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MORNING SICKNESS More commonly seen in first trimester. Appear soon following the missed period rarely lasts beyond the 1 st trimester.. Starts around 4 th to 6 th week and continues till 16 th . Appears in the form of nausea and vomiting.. Causes : HCG, delayed gastric emptying HYPEREMESIS GRAVIDARUM : weight loss, dehydration, acidosis and hypokalemia due to vomiting.. Treatment can be given by I.V crystalloid solutions & anti emetic..

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SALIVATION & CHANGES IN DISPOSITION Salivation; an early symptom Change in disposition may be shown by a change in temperament, resulting in the patient becoming irritable and capricious.. Not of diagnostic value, as they are purely subjective and occurs in various other neurologic conditions as well.. FATIGUE Early fatigability is frequent in early pregnancy

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Frequency of micturition Increased during 8 th to 12 th week of pregnancy.. Reasons: Resting of bulky uterus on fundus of bladder, Congestion of bladder mucosa, Change in maternal osmoregulation causes increased thirst & polyuria BREAST DISCOMFORT Feeling of fullness & pricking sensation at around 6 th to 8 th week specially in primigravidae..

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Changes evident between 6 th to 8 th weeks. Enlargement with vascular engorgement & delicate veins visible under skin. Appearance of primary and secondary areolae.. Montgomery’s follicles appear first on primary and then on secondary areola.. Fluid containing colostrum corpuscles detected from 12week onwards..

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Pelvic changes Certain signs are seen which are summarized below: SIGN FEATURE SEEN IN JACQUEMIER’S/ CHADWICK’S Sign Dusky hue of vestibule & anterior vaginal wall due to local vascular congestion 8 th week of pregnancy & in pelvic tumors like fibroid.. OSIANDER’S Sign Increased pulsation felt through lateral fornices 8 th week of pregnancy and in acute PID GOODELL’S Sign Softening of cervix 6 th week of pregnancy and oral contraceptive pill users..

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Cervix feels like tip of nose in non pregnant women Cervix feels like lip of mouth in pregnant women

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LADIN’S Sign : at 6 weeks, uterus softens in midline along uterocervical junction.. Mc DONALD’S Sign : uterus becomes flexible at uterocervical junction at 7-8 weeks.. VON FERNWALD Sign : softening of fundus at 4-5 weeks..

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Other Changes Taking Place in Cervix And Vagina Are: Goodell’s sign Bluish discoloration of cervix Jacquemier’s/ Chadwick’s sign Osiander’s sign Bluish discoloration of anterior vaginal wall Walls become soft Copious non-irritating discharge around 6 th week..

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Size, shape and consistency In 1 st trimester it grows to size of hen’s egg at 6 th week, cricket ball size at 8 th week and size of fetal head by 12 th week.. Pyriform shape of non-pregnant uterus becomes globular by 12 weeks.. PISKACEK’S SIGN Asymmetrical enlargement of uterus if there is lateral implantation; One half of uterus is more firm than the other half in the condition.

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Uterine Changes are also associated with few other signs… SIGN FEATURE SEEN IN HEGAR’S Sign On bimanual examination with two fingers of other hand behind the uterus, the abdominal and vaginal fingers seem to appose below the body of uterus. It occurs due to softening of isthmus. Present in two-third cases and is demonstrated between 6-10 weeks.. PALMER’S Sign Regular and rhythmic contraction which can be felt on bimanual examination 4- 8 week

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ultrasonography Identification of Intra Decidual Gestational sac is identified as early as 29 to 35 days of gestation. Embryonic movements are seen by 7 weeks.. Doppler effect of ultrasound can pick up the fetal heart rate reliably by 10 th week..

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It can be diagnosed by: symptoms Subjective symptoms such as nausea, vomiting, etc. gets subsides.. quickening Perception of active fetal movements felt by 18 weeks of pregnancy in primipara and 2 weeks earlier in multipara. Useful to calculate the EDD with reasonable accuracy..

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General symptoms Two types changes are seen.. SIGN FEATURES SEEN AT Cholasma Pigmentation over forehead and cheeks 24 th week of pregnancy Breast changes Appearance of secondary areola Secretion of colostrum Thickening of colostrum 16 th to 20 th week of pregnancy

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Abdominal examination

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INSPECTION LINEA NIGRA It is a linear pigmented area stretching from umbilicus to symphysis pubis.. Visible as early as 20 th week LINEA ALBICANTES On either side of abdominal wall are other striae; both pinkish and whitish in color

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SIGN FEATURE SEEN AT Size Fundal height is increased with progressive enlargement of uterus Height of uterus midway between symphysis pubis & umblicus At level of umblicus At junction of lower third and upper two-third of distance between umblicus and eusiform cartilage Uterus becomes soft & elastic 16 th week 24 th week 28 th week Uterine changes are as follows:

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The level of fundus uteri at different weeks .. Note the change of uterine shape..

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SIGN FEATURE SEEN AT BRAXTON-HICKS CONTRACTIONS Irregular, infrequent spasmodic & painless contractions without any effect on dilation of cervix.. (intrauterine pressure is less than 8mm of Hg) Begins in early pregnancy and continues till term Palpation Of Fetal Parts & Active Fetal Movements Positive sign of pregnancy Elicted by 20 weeks

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Ballottement of uterus It is of two types: TYPE FEATURE SEEN AT EXTERNAL Elicit when fetus is relatively smaller than volume of amniotic fluid Difficult in obese person & in case with scanty liquor amni Best elicited in breech presentation Around 20 th week INTERNAL On bimanual examination gives impression of floating object in uterus. May be seen in case of uterine fibroid, ascites or ovarian cyst From 18 th week onwards..

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Steps showing how to elicit internal ballottement

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auscultation Auscultation of fetal heart sounds; most conclusive sign of pregnancy Heard by stethoscope between 18 to 20 weeks of pregnancy Fetal cardiac motion can be detected by Doppler by 10 weeks The rate varies from 110-160 beats/minute.

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The confusing sounds The fetal sounds may be confused with: UTERINE SOUFFLE Soft blowing & systolic murmurs, heard low down at sides of uterus especially on left side. FUNIC OR FETAL SOUFFLE Soft, blowing murmur synchronous with the fetal heart sounds. It is due to rush of blood through umbilical arteries.

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Bluish discoloration of vulva, vagina and cervix is evident for pregnancy so also softening of cervix. Internal ballottement is also very useful for the diagnosis.. It can be elicited between 16 th -28 th week..

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SONOGRAPHY : at 18 to 20 weeks permits a detailed survey of fetal anatomy, placental localization & integrity of cervical canal Fetal organ anatomy is surveyed to detect any malformation. Fetal viability is determined by real-time ultrasound. Absence of fetal cardiac motion confirms fetal death. Radiologic evidence of fetal skeletal shadow may be visible as early as 16 th week..