Diagnosis of Pregnancy

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Diagnosis of Pregnancy

• Liu Wei
• Department of Ob Gy
• Ren Ji hospital

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Diagnosis of Early Pregnancy

• History and symptoms
• Amenorrhea
• The first and the most important symptom
• Note 1 emotional tension, chronic disease and
  certain medications ? delayed menses
• Note 2 lactation, IUD and dysfunction of
  endocrine ? pregnancy

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Diagnosis of Early Pregnancy

• Morning sickness
• Fatigue, swirling, nausea and vomiting (the 6th
  week? ? the 12th week? ).
• Hyperemesis gravidarum (????) protracted
  vomiting necessitating hospitalization.
• Causes HCG, delayed gastric emptying(P? )

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Diagnosis of Early Pregnancy

• Urinary symptoms
• Bladder irritability, frequency and nocturia
• Causes increased circulation in pelvis (E and
  P?), enlargement of the uterus.
• Note urinary infection must be ruled out

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Diagnosis of Early Pregnancy

• Mastodynia (????)
• the development of mammary ducts (E?) and
  alveolar system (P?)
• circulation?? engorgement of the breasts
• Constipation (??)
• smooth muscle relaxant (P?)
• Weight gain

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Diagnosis of Early Pregnancy

• Signs
• The changes of genital organs
• Vagina bluish or purple discoloration (congested
  pelvic vasculature). Increased vaginal discharge
  (E and P?)
• Cevix softening and bluish discoloration. The
  cervical mucus? a granular pattern
• Uterocervical junction
• Hegars sign a widened zone of softness coupled
  with compressibility, resulting in a
  doughnut-shaped, slightly spongy configuration.

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Hegars sign
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Diagnosis of Early Pregnancy

• Abdominal enlargement
• Enlargement of uterus (noticed at the 12th
  week)
• Breast changes
• Enlargement and vascular engorgement (6th 8th
  week)
• Montgomerys tubercles (????) 6th 8th week, E
  and P?
• Colostrum secretion (16th week) or secondary
  breasts

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Diagnosis of Early Pregnancy

• Laboratory tests
• Pregnancy test
• Urine HCG test (one step) or
• ß-HCG gt25mIU/L
• Ultrasonography
• Enlargement of uterus
• Gestational sac
• Embryo or fetal pulse

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Diagnosis of Early Pregnancy

• Other tests
• Progesterone test
• Cervical mucus examination
• Basal body temperature (BBT)

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Diagnosis of mid or late pregnancy

• Symptoms and signs
• EDC 9 or 3 (month), 7 (day)
• Enlargement of uterus
• 12th week 2 finger above the symphysis
• 16th week midway between the symphysis and the
  umbilicus.
• 20th 22nd week at the umbilicus
• .

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Diagnosis of mid or late pregnancy

• Fetal movement (FM)
• The first perception in the 18th 20th weeks
• Diagnosis of pregnancy, duration of pregnancy,
  the safety of fetus
• Count 3 times per day, 1 hour per time. sum4
  FM/12 hours. Normal 30/12 hours

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Diagnosis of mid or late pregnancy

• Fetal heart tones
• Heared the 18th 20th weeks
• Normal rate 120-160bpm
• Differentiation umbilical souffle (????)
• Fetal body
• Palpated outlines of the fetus (the 20th
  week).

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Diagnosis of mid or late pregnancy

• Laboratory tests
• Ultrasonography
• The number of fetus
• Fetal lie
• Fetal presentation
• Fetal position
• Fetal dead or not
• Placenta and cord (velocity of flow)
• Size of fetus

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Diagnosis of mid or late pregnancy

• Fetal electrocardiography, FECG
• 12th week

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Fetal Attitude

• Fetal lie
• Refers to the relationship of the long
  axis of the fetus to the long axis of the mother
• Longitudinal lie
• The long axis of the fetus is parallel
  with that of the mother
• Transverse lie
• The long axis of the fetus crosses that of
  the mother vertically

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Fetal lie
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Fetal Attitude

• Fetal presentation
• head presentation
• Occiput presentation (95), brow
  presentation and face presentation.
• Breech presentation
• Complete breech presentation
• Frank breech presentation
• Incomplete breech presentation footling
  presentation

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Head presentation or breech
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Fetal Attitude

• Fetal position
• Refers to the relationship of the point of
  direction of the presenting part to one of the 4
  quadrants of the pelvis or to the transverse
  diameter of the maternal pelvis.
• Occiput presentation the occiput, O. LOA,LOT,LOP
• Face presentation the chin, M. LMA,LMT,LMP
• Breech presentation the sacrum, S.LSA,LST,LSP

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Fetal position
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END