Diagnosis of pregnancy

Diagnosis of pregnancy

Objectives of the lecture
To learn how to manage a most common obstetric condition To avoid social problems occurred by miss diagnosis

Diagnosis of Early Pregnancy

History and symptoms 1.Amenorrhea The first and the most important & common symptom 2.Breast symptoms tenderness &fullness 3.Morning sickness 4.Frequency of micturition&nocturia 5.Fetal movement

symptoms

6.Fainting ,dizziness &fatigue As blood vessels dilate & blood pressure drops,pregnant feels light headache or dizzy Early in pregnancy,faitness may also triggered by low blood sugar. 7.Constipation. 8.Weight gain 9.Abdominal enlargement:

1. Signs due to changes in the uterus: a-Enlargement of the body of the uterus: it is the earliest alteration which can be detected on clinical examination. the uterus becomes globular.


b-.Softening of the uterus and cervix Hegar's sign: As uterine consistency becomes softer, it may be possible to palpate or to compress the connection between the cervix and fundus. The Hegar's sign is noted by the sixth to eighth week of pregnancy.

Hegar’s sign

2. other changes of the genital tract Vagina :bluish or purple discoloration &increase in vaginal discharge Cervix :softening &bluish discoloration


3.Signs due to changes in the breasts primary areola secondary areola Montgomery tubercules Colostrums

4.Progressive enlargement of the uterus:

5.Painless contractions: Braxton Hicks contractions usually begins about the 12th week of pregnancy and becomes progressively stronger.so the uterus varies in consistency on palpation

10.Skin changes Chloasma. linea nigra striae gravidarum

Laboratory tests for pregnancy:
urine pregnancy test: usually positive on day 35 from LMP serum pregnancy test; usually positive 7-10 days after conception

Confirming the diagnosis of pregnancy

ultrasonographic recognition of the gestational sac as early as 4-5 weeks Fetal heart activity → real time US show fetal heart after 6 weeks of gestation


Differential diagnosis of pregnancy
: 1-uterine fibroids: 2-ovarian cyst 3- distended bladder

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Pseudocyesis

Is a psychological disorder in which the woman has a false but fixed idea that she is pregnant. It is frequently, but not always, seen near or after the menopause, and not invariably in woman without children. There may be amenorrhoea, and the woman may declare that she has morning sickness and breast enlargement, and that she can feel fetal movements. The abdomen may appear distended, either by air collected in the stomach by aerophagy, by intestinal distension, by persistent contraction of the diaphragm or exaggerated lumber lordosis or sometimes just by fat.

pseudocyesis

The shape of the swelling is not that of the pregnant uterus, fetal parts cannot be felt and the fetal heart cannot be heard. A pregnancy test or ultrasound scan will be required but the difficulty is to convince the woman that she is not pregnant.

Case history

A 32 years lady with irregular cycle due to lactation she her last menstrual period was from 4/8/2017 What is the differential diagnosis? How do you reach the diagnosis? If she is pregnant how many weeks is the gestational age