IN THE NAME OF GOD

Diagnosis of pregnancy

Signs&symptoms

— Most women experience some signs or symptoms of pregnancy as early as three weeks after conception The most common symptoms of early pregnancy are: 1-Amenorrhea 2-Nausea with or without vomiting 3-Breast tenderness 4-Increased frequency of urination 5-Fatigue

1-Cessation of menses: In healty reproductive age Who has spontaneous cyclical mense 10 days or more after expected mense onset Uterin bleeding somewhat suggestive of menestration occurs occasionally after conception Such episods are interpreted to be physiological&likely the conseqence of blastocyste implantion

Nausea and vomiting :  The term "morning sickness" refers to the tendency of most pregnant women to develop nausea, often with vomiting, between 6 and 12 weeks of gestation. This nausea is typically worse in the morning and tends to improve as the day progresses, but can occur at any time of day. Hyperemesis gravidarum may be considered the severe end of the spectrum of symptoms

If nausea and vomiting are accompanied by pain, fever, vertigo, diarrhea, headache, or abdominal distension, a cause other than pregnancy should be considered. The onset of nausea and vomiting after the first 12 weeks of pregnancy should also prompt an evaluation because this is after the typical period expected for pregnancy-related nausea and vomiting.

Urinary frequency : Urinary frequency and nocturia are common pregnancy-related complaints. The major factor in the physiology of nocturia appears to be that pregnant women excrete larger amounts of total solute and sodium during the night than nonpregnant women. Cystitis should be suspected if dysuria, hematuria, or pyuria is present

Fatigue : Fatigue is common in the first trimester, but becomes less prominent in the second trimester. The exact cause is not clear; possibilities include the rapid, large increase in the concentration of progesterone (which may exert a soporific effect) and the extensive cardiovascular/hematological changes (which increase cardiac output)

Change in cervical mucus: Driect cervical mucus examined microscopically Mucus crystallization necssaary for the Na/Cl)).production of the fern pattern

:CHANGES BREAST :

The breasts become fuller, tender, and the areolar area darkens The breasts become fuller, tender, and the areolar area darkens. The venous pattern under the skin covering the breasts becomes increasingly visible as pregnancy progresses

Anatomical changes of brests are characteristic during the first of pregnancy these are less obvious in multiparas Brest may contain a small amount of milky material or colostrum for months or even years after the birth of their last child

Vaginal mucosa: usually appears dark blunish or purplish red&congested(chadwick sign) Skin changes: Increased pigmentation Abdominal striae

The uterus: becomes enlarged and globular. It increases in size by about 1 cm per week after four weeks of gestation. The uterus remains a pelvic organ until approximately 12 weeks of gestation, when it becomes sufficiently large to palpate abdominally just above the symphysis pubis.

The cervix and uterus : soften (Goodell sign and Hegar sign, respectively). This allows the examiner to easily flex the uterine body against the cervix (McDonald sign). This occurs at about six weeks of gestation. Because of the increased blood supply to the uterus, the mucous membranes of the vulva, vagina, and cervix become congested and take on a bluish-violet coloration (Chadwick sign). This occurs at about 8 to 12 weeks of gestation

Preception of fetal movment Between(16 &18weeks) In primi gravida two week later (18 to20weeks)

:Pregnancy test Serum&urineHCG HCG prevents involution of corpus luteum the principal site of progesterone fornation during the first 6weeks With a senstitive test HCG detected at8 to9 day after ovulation& reach peak levels at 60 to 70 days then declline slowly until 16 weeks

Home pregnancy test: They are very popular and work by detecting hCG in the urine using. A woman may say that her HPT was negative and ask if this means that she is not pregnant. Specific questions to ask her include the following:   (1) How many days after your missed period did you perform the test?   (2) Did you understand how to do the test and feel comfortable doing it?   (3) What brand of HPT did you use?   (4) Did you repeat the test and get a similar result?

Urine pregnancy test :  Urine pregnancy testing is the most common method used to confirm pregnancy in the office setting. and take only one to five minutes to perform. Immunometric tests specifically identify the beta subunit of hCG, thus rendering cross-reaction with subunits of other hormones, such as LH,FSH, and TSH, unlikely. Of note, a positive test indicates the presence of hCG from any source; it does not exclude the possibility of an EP or nonviable IOP, GTD, or some types of ovarian tumors.

Sonographic recognition of pregnancy: Gestational sac in TAS may be demonstreated after only 4to5 week 35 days after lmp GS is seen in all women FHR AT 6TO7 WEEK IS SEEN