Diagnosis of Pregnancy

Review
Pregnancy (gestation)
Fetal Growth And Development
Fetal appendage
Maternal physiology during pregancy

Multiple choice questions

Hormone X is secreted in the follicular phase and are
responsible for suppressing FSH in the late follicular phase prior
to ovulation. What is hormones X ?
(A) LH
(B) FSH
(C) progesterone
(D) estrogen
(E) testosterone
3

If you are a doctor in clinic

Female, 25 years old, married, normal
menstrual cycle, not contraception,
the first day of the last menstrual
period (LMP) is 2011/01/20
Now she come to
How consider about ?
4

ectopic

First
trimester

GTD

lactation

Impuberal
postmenopause

cessation
cessation menstruation
menstruation

DUB

PCOS

General
disease

neoplasms

Diagnosis of pregnancy
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Diagnosis of pregnancy
almost the most important in women life to others
Medical doctors have the knowledge about
pregnancy important ,no matter how the practice characteristics and
professional

Whether she was pregnant ?

Incorret diagnosis and inappropriate
treatment judicial intervention

The Whole Period of Pregnancy Divided

Into Three Stages:
The whole process of pregnancy from the first day of the last menstrual period (LMP) with an average 280 days, 40
weeks

The first trimester (early pregnancy): 1-12w

The second trimester (middle pregnancy): 13-27 w
The third trimester (late pregnancy): 28-40w

Diagnosis of Early Pregnancy

History and symptoms on the basis of a history enlarging uterus and a positive
pregnancy test.

1.

Amenorrhea
The first and the most important symptom with regular menstrual cycles

emotional tension, chronic disease , certain medications

genitourinary tumors delayed menses

Differential Diagnosis lactation, oral contraception,

endocrine disorder

Diagnosis of Early Pregnancy

2. Morning sickness
Nausea and vomitingoccurs in about 50% of pregnancies. (the 6th week
the 12th week )
Causes: HCG, delayed gastric emptying(P )

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Diagnosis of Early Pregnancy

3. Urinary symptoms
Bladder irritability, frequency and nocturia
Causes:
increased circulation in pelvis (E and P )
enlargement of uterus.
Differential Diagnosis: urinary infection
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Diagnosis of Early Pregnancy

4.

Mastodynia

breast tendeness from tingling to frank

pain

Causes:

the development of mammary ducts (E)

and alveolar system (P)

circulation engorgement of the breasts

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Diagnosis of Early Pregnancy

Signs
1 The changes of genital organs
Vagina: bluish or purple discoloration (congested
pelvic vasculature). Increased vaginal discharge (E
and P )
Cevix: softening and bluish discoloration.
Enlargement of uterus (noticed at the 12th week )

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Diagnosis of Early Pregnancy

Hegars sign: Widening of the softened area of the
isthmus, in compressibility on bimanual examination.

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Diagnosis of Early Pregnancy

2. Breast changes

Enlargement

the development of mammary ducts and

alveolar system

engorgement of breasts

sebaceous glands( Montgomery's

tubercles)
Linea Nigra :darkening of Nipples.

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Diagnosis of Early Pregnancy

Assistant Examination
1

Pregnancy test the simplest and most common method

Urine HCG test : + or

Urine HCC test + about 95% of the possibility of pregnancy

blood -HCG: a sensitive and specific test , early pregnancy tests

identification of human chorionic gonadotropin ( hCG)as early as 7-9 days
after fertilization

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blood -HCG + about 99% of the possibility of pregnancy

Pregnancy test
Urine HCG test

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Diagnosis of Early Pregnancy

2. Ultrasonography
Enlargement of uterus
Gestational sac
Embryo or fetal pulse at 5-6 week
Crown to rump length(CRL)
measured at 5 -12 weeks the most accurate gestational
age.

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Genetic screen/prenatal screen

nuchal translucency NT
Early pregnancy signs commonly used in genetic screening

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First Trimester Down syndrome screening

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Teratogenic fetal organs of the sensitive period map

For structural malformations,embryo is the most important, Continued development of functional is very important at fetus

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Diagnosis of Early Pregnancy

3. Basal body temperature
(BBT)
A persistent elevation of BBT for longer than 18 days
may be presumptive evidence of pregnancy.

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Diagnosis of Early Pregnancy

4. Progesterone test
Progesterone given to amenorrhea.

pregnant, no bleeding follow

nonpregnant bleeding should

occur within 7-10 days of
progesterone

adequate estrogen stimulation

of the endometrium.

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Diagnosis of Early Pregnancy

5. Cervical mucus
The cervical mucus smear
a progestational effect
ellipsoid fern crystallization.

cervical mucous
(1) type ( ) typical fern crystallization
(2) type ( ) fern crystallization
(3) type ( ) atypical fern crystallization
(4) type ( ) ellipsoid
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Diagnosis of mid or late pregnancy

History Symptoms and
sign
Early pregnancy course
Abdomen gradually increasing

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Diagnosis of mid or late pregnancy

Symptoms and sign
1. Enlargement of uterus

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12th week: 2 finger above the symphysis

16th week: midway between the symphysis and the umbilicus.

20th week: at the umbilicus

24th week: 2 finger above the umbilicus.

28th week:3 finger above the umbilicus.

32th week: midway between the umbilicus and xiphoid bone

36th week: 2 finger below the xiphoid bone

40th week: midway between the umbilicus and xiphoid bone

Diagnosis of mid or late pregnancy

2. Fetal movement (FM)

The first perception: in the 18th 20th weeks multipara /primipara

Diagnosis of pregnancy, the safety of fetus

Count: 3 times per day

1 hour per time. sum4= FM/12 hours
Normal: 4/ hour , 30/12 hours

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Diagnosis of mid or late pregnancy

3. Fetal heart tones

Heared: the 18th 20th weeks by fetoscope /the 10th weeks by

Doppler ultrasound

Normal rate: 120-160 bpm beats per minute

Differentiation: umbilical souffle etc

4. Fetal body
Palpated: outlines from maternal abdominal wall(the 20th week).
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Diagnosis of mid or late pregnancy

Assistant Examination

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Ultrasonography

Measure
fetal growth parameter
amniotic fluid volume
placenta
umbilicus cord

Diagnosis of mid or late pregnancy

Assistant Examination

Ultrasonography Normal

Exclusion fetal malformations spine

NTD
anencephalus
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Spinal cleft

Diagnosis of mid or late pregnancy

Assistant Examination
Ultrasonography
Size of fetus:fetal biparietal diameter/ Fetal femur length/abdominal
circumference
Fetal well-being :measure biophysical characteristics.
Placenta maturity
Amniotic fluid volume
Umbilical Cord Blood
number of fetus

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Diagnosis of mid or late pregnancy

Fetal electrocardiography
FECG
12th week

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Fetal Attitude
The posture of fetus in the uterus
Fetal lie
the relationship of the long axis of the fetus to the long axis of
the mother
Longitudinal lie
long axis of fetus parallel with mother
Transverse lie
long axis of the fetus vertical mother
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Fetal Attitude
Fetal presentation: first part of the fetus into pelvic
head presentation

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Occiput presentation (95%)

anterior fontanelle presentation
brow presentation
face presentation

Fetal Attitude
Fetal presentation

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Breech presentation
Complete breech presentation
Frank breech presentation
Incomplete breech presentation: footling presentation

Fetal Attitude
Fetal position
relationship of the point of direction to one
of the 4 quadrants of the pelvis
Occiput presentation: the occiput, O.
LOA,LOT,LOP
Face presentation: mandibular,M.
LMA,LMT,LMP
Breech presentation:sacrum,S.
LSA,LST,LSP
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symptoms and signs of pregnancy diagnosis

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Summary
Whole pregnancy process by stages
Diagnosis of Early Pregnancy
Diagnosis of mid or late pregnancy
Fetal Attitude

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The Whole Period of Pregnancy Divided

Into Three Stages:
from the first day of the last menstrual period (LMP) with an average 280 days, 40 weeks

The first trimester (early pregnancy): 1-12w

The second trimester (middle pregnancy): 13-27 w
The third trimester (late pregnancy): 28-40w

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Diagnosis of Early Pregnancy

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History and symptoms:

Amenorrhea

Assistant Examination
Pregnancy test

Morning sickness

Urinary symptoms

Ultrasonography

Mastodynia

Signs

Basal body temperature

The changes of genital organs

Breast changes

Progesterone test
Cervical mucus

Diagnosis of mid or late pregnancy

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History and symptoms:

Early pregnancy course

Abdomen gradually increasing

Symptoms and Signs

Enlargement of uterus

Fetal movement

Fetal heart tones

Fetal body

Assistant Examination
Ultrasonography
Fetal electrocardiography

Fetal Attitude
Fetal lie
Fetal presentation
Fetal position

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If you are a doctor in clinic

Female, 25 years old, married, normal
menstrual cycle, not contraception,
the first day of the last menstrual period
(LMP) is 2011/01/20
Now she come to
How consider about ? How do you do first?

43

THANKS FOR YOUR ATTENTION!

44

Thanks for Your Attention