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DIAGNOSIS OF PREGNANCY

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BY

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ONYEJI JOHN

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OB/GYN DEPARTMENT

JUTH

15/01/14

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OUTLINE

  • INTRODUCTION
  • RELEVANCE OF EARLY DIAGNOSIS
  • DIAGNOSIS
  • First trimester
  • Second trimester
  • Third trimester
  • CONCLUSION

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INTRODUCTION

  • Pregnancy is the maternal condition of having a developing fetus in the body.

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  • Every physician who assumes the responsibility for the medical care of women of reproductive age should be able to recognize pregnancy.

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  • The implication of not diagnosing pregnancy is grievous.

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INTROD CONT

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  • In most women, diagnosis of pregnancy is usually straight forward based on a history of amenorrhea and a positive pregnancy test

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  • For women with irregular menstruation or irregular vaginal bleeding, the diagnosis of pregnancy is more complex.

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INTROD CONT

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  • However, it is very rare for the diagnosis to be impossible if appropriate clinical and laboratory tests are carefully conducted and evaluated.

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RELEVANCE OF EARLY DIAGNOSIS

  • To prevent exposure of fetus to hazardous substances(x-rays,teratogenic drugs).

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  • To manage ectopic or non-viable pregnancies.

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  • To provide better health care for the mother & fetus
  • Litigation

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DIAGNOSIS OF PREGNANCY

FIRST TRIMESTER

Symptoms

  • Amenorrhea. ▲E2 &P4 produced by corpus luteum; has drawbacks

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  • Nausea and vomiting. Occur in 50% of pregnancies. At around 2-12weeks.Due to rapidly rising serum hcG 100,000mIU/ml.

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FIRST TRIMESTER DIAGNOSIS CONT.

  • MASTODYNIA. Tingling to frank pain caused by hormonal responses of the mammary ducts and alveolar system

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  • Increase urine frequency, disappears after 1st trimester

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  • Easy fatiguability & sleepiness
  • Emotional changes

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FIRST TRIMESTER DIAGNOSIS CONT.

  • SIGNS
  • Basal Body Temperature.▲over a 3 wk period.

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  • Increase pigmentation of nipple and areola

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SIGNS OF PREGNANCY AT FIRST TRIMESTER CONT.

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  • MONTGOMERY’S TUBERCLES. Enlargement of circumlacteal sebaceous glands of the areola. This occurs at 6-8wks
  • ALL THESE ARE PRESUMPTIVE MANIFESTATIONS OF PREGNANCY
  • Auscultation using sonicade(10-12 wks)
  • Handheld doppler (8wks)

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FIRST TRIMESTER SIGNS OF PREGNANCY CONT.

PROBABLE MANIFESTATIONS

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  • CHADWICK’S SIGN. Bluish or Purplish discoloration of the vagina and cervix(6-8wks).

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  • LEUKORRHEA. ▲Vagina discharge and cervical mucus. Due to hormone stimulation.

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  • GOODELL’S SIGN. Cyanosis and softening of the cervix. This occur as early as 4 wks.

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FIRST TRIMESTER SIGNS OF PREGNANCY CONT.

  • LADIN’S SIGN. The uterus softens in the anterior midline along the uterocervical junction. This is seen at 6 wks.

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  • HEGAR’S SIGN. This is widening of the softened area of the isthmus, resulting in compressibility of the isthmus. This occur by 6-8wks.

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  • MC DONALD’S SIGN. The uterus becomes flexible at the uterocervical junction at 7-8wks.

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FIRST TRIMESTER SIGNS OF PREG. CONT.

  • VON FERNWALD’S SIGN. An irregular softening of the fundus develops over the site of implantation at 4-5wks.

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  • PISKACEK’S SIGN. An irregular softening of the cornual area.

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  • JAQUEMIER’S SIGN. Change in color of the vaginal and cervix (purplish/bluish) occur around the 8th week.

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DIAGNOSIS

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  • OSIANDER’S SIGN. Pulsations around the lateral fornix's of the vaginal.This occur from the 8th week

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FIRST TRIMESTER INVESTIGATIONS

PREGNANCY TEST

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  • URINE: dipstick- hCG detected 42 days after the LMP

ELISA

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Agglutination test:sheep erythrocyte coated with antihcG

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Agglutination inhibition test

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FIRST TRIMESTER INVESTIGATIONS

PREGNANCY TEST

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  • BLOOD: Dipstick- hCG produced 8 days after fertilization, may be detectable in serum by day 9.It peaks 65 days after conception.
  • Radioimmunoassay: quantitative value of >5iu/L denotes pregnancy
  • ELISA
  • Agglutination test/Agglutination inhibition test

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  • POSITIVE TEST: 30-35mIU in serum or urine.

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CAUSES OF FALSE POSITIVE PREG. TEST

  • Proteinuria

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  • Haematuria

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  • At time of ovulation :cross reaction with LH

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  • hcG injection for fertility treatment within the previous 30 days
  • Thyrotoxicosis (high TSH)

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CAUSES OF FALSE POSITIVE PREG. TEST CONT.

  • Premature menopause(high LH & FSH)

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  • Early days after delivery or abortion

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  • Trophoblastic disease

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CAUSES OF FALSE NEGETIVE PREG. TEST

  • Missed abortion
  • Too early pregnancy < 9 days

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  • Urine stored too long in room temperature

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FIRST TRIMESTER INVESTIGATION CONT.

ULTRASOUND EXAMINATION OF THE FETUS

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  • GSD: 5-6wks TAS

4-5wks TVS

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  • CARDIAC ACTIVITY: 7wks TAS

5-6wks TVS

CRL 8-13 wks

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DIAGNOSIS OF PREG. IN 2ND TRIMESTER

  • QUICKENING. The first perception of the fetal movement;18-20wks primip,14-16wks

multip

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Chloasma gravidarum:Darkening of skin over forehead, nose bridge and checkbones(occurs over 16wks)

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DIAGNOSIS OF PREG. IN 2ND TRIMESTER

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Linea nigra : Darkening of abdominal skin along the linea alba; due to MSH

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DIAGNOSIS

  • STRIAE GRAVIDARUM. Separation of the underlying collagen tissue. This is probably an adrenocorticosteroid response.

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  • SPIDER TELANGIECTASES. Vascular stellate marks that blanch when compressed. Due to ▲E2.

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DIAGNOSIS

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  • COLOSTRUM SECRETION. Begins after 16wks.

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  • SECONDARY BREASTS. May become more prominent both in size and in coloration. This occur along the nipple line.

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DIAGNOSIS

Progressive increase in abdominal size

use measuring tape

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abdominal landmarks

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DIAGNOSIS

  • UTERINE CONTRACTIONS. Braxton hick’s felt as tightening or pressure. They usually begin about 28wks.

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  • BALLOTEMENT OF THE UTERUS. This is done at 16-20wks.

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  • UTERINE SOUFFLÉ. Auscultation of the abdomen. After 16wks often elicits a rushing sound synchronous with the pulse.

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DIAGNOSIS

POSITIVE MANIFESTATIONS

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  • FETAL HEART TONES.
  • Sonicade, Fetoscope 17-18wks.
  • Ultrasonography

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  • BPD, FL, AC 14-20WKS

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DIAGNOSIS

X-RAY OF FETUS

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The ossified fetal bones appear at:

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    • 12wks- Vertebral bodies and ribs.
    • 20wks- Semi-circular canals and parietal bones.
    • 24wks- Calcaneum.
    • 26wks- Talus.
    • 36wks- Lower femoral epiphysis.
    • 38wks- Upper tibia epiphysis.
    • 40wks- Cuboid.

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THIRD TRIMESTER DIAGNOSIS OF PREGNANCY

  • USS
  • Progressive increase in abdominal size( SFH, Landmark)
  • X-ray

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CONCLUSION

  • The endocrinological,physiological and anatomical alterations that accompany pregnancy give rise to symptoms and signs that provide evidence that pregnancy exist.

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  • Every physician should be conversant with these features for a correct diagnosis of pregnancy to be made.

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THANK YOU FOR LISTENING

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