dx of pregnancy

Diagnosis of Pregnancy

Dr. sarab salih
SYMPTOMS AND SIGNS OF PREGNANCY:-
Amenorrhea: is the first suggestion of pregnancy in most women with regular cycle . Decidual bleeding , women may continue to bleed in early pregnancy at the time of suppressed mense , may continue to about 12 weeks
Nausea or sickness: Many women suffer some gastric upset in the early months of pregnancy-from nausea and anorexia to repeated vomiting-especially in the morning. Raised levels of Oestrogen and HCG have been blamed. Gastric motility is reduced , and in early pregnancy , the lower oesophageal sphincter is relaxed.
Bladder symptoms :
Increased frequency of micturition in the second and third months is due to:
1) Increased vascularity
2) Pressure from the enlarging uterus
Near term , frequency may again appear due mainly to pressure of the fetal head on the bladder.

Breast changes :
Increased vascularity and feeling of heaviness, almost of pain appear at 6 weeks.
Primary areola ; The nipple and surrounding area become more pigmented by 8 weeks . Montgomery’s tubercles are sebaceous glands which become more prominent as raised –pink –red nodules on the areola.
)) Secondary areola ; a mottled effect due to further pigmentation , become prominent by 20 weeks.
Colostrum is a clear fluid which is secreted by 16 weeks and may also be expressed.

Uterine changes:
Uterine enlargement may be detected on bimanual examination at 7-8 weeks
Palpable uterine enlargement:
At 7 weeks the uterus is the size of a large hen’s egg.
At 10 weeks it is the size of an orange.
At 12 weeks it is the size of a grape fruit
By 12 weeks the uterus is palpable abdominally.
By 22 weeks the fundal height nearly at the level of the umbilicus.
Lightining ; is reduction in the fundal height that may occur at the end of pregnancy.





Palpable uterine contractions: Braxton Hicks are palpable uterine contractions on abdominal exam . at 20 weeks ,become more frequent as pregnancy advances
Quiqening: Awareness of fetal movement for the first time , may be felt at 16-18 weeks in parous women and 2-3 weeks later in primi
Auscultation of the fetal heart by two methods:
Pinard : From about 24-26 weeks
Sonic aid : From 12-14 weeks
Palpable fetal parts:
These can be felt from around 26 weeks
Skin changes:
Areas which are already pigmented become more so including the nipples, external genitalia , and anal region and these increase as pregnancy advance.
Some fresh pigmentation appear
Cloasma on the face.
The Linea nigra on the abdomen.
Striae gravidarum , are depressed streaks on the skin of fat areas including abdomen, breasts , and thighs .After delivery they regress and persist as striae albicans , they are due to stretching ,but may be associated with increased secretion of ACTH affecting connective tissues.

Presumptive signs :-

i- Cessation of mense.
ii- Breast tenderness and swelling.
iii-Nausea and vomiting.
iv-Changes in the skin and mucous membranes
1)) Chadwick’s sign ((discoloration of the vulva ,vagina , and cervix)).
2)) Increased skin pigmentation.
3)) Development of abdominal striae


Probable signs :-
A- physical changes in the uterus:
1) Uterine enlargement.
2) Hegar’s sign.
3) Uterine contraction.
Palpation of fetal parts.

Positive signs :-

Auscultation of the fetal heart tones.
Recognition of fetal movement by external examiner.
Imaging the fetus by sonogram.