DIAGNOSIS OF PREGNANCY Dr. Madhavi Karki

Pregnancy is divided into three trimester. The reproductive age of women begins at menarche and ends in menopause. It usually varies from 15-45yrs. Pregnancy is divided into three trimester. First trimester consists from 1-13wks. Second trimester consists of 14-28wks. Third trimester consists of 29-40wks.

FIRST TRIMESTER SYMPTOMS 1. AMENORRHEA 2. MORNING SICKNESS The normal menstrual cycle is stopped. This is earliest and strongest symptoms of pregnancy. 2. MORNING SICKNESS Anorexia, nausea, vomiting and sleeping tendency. It occurs especially in morning. It occurs in 50% of cases and is more in the first pregnancy. It occurs due to increasing circulating estrogen. It passes off after 3 months. Usually it doesn’t affect the health status of the mother.

3. Frequency of the micturation increases in 8-12th weeks of pregnancy 3. Frequency of the micturation increases in 8-12th weeks of pregnancy. It is due to a. resting of the bulky uterus on the fundus of the bladder , b. congestion of the bladder mucosa and c. stretching of the bladder base due to the backward displacement of the cervix. As the uterus straightens up after 12th week the symptoms disappear. 4. Breast discomfort in the form of feeling of the fullness and pricking sensation is evident on 6-12th week. 5. Fatigue, constipation and back pain is the frequent symptom of the pregnancy.

2. Abdominal examination:- SIGNS:- 1. Breast changes:- Enlargement with increase vascularities. Pigmentation of nipple and areola. Montgomery's tubercle. Colostrum can be expressed from 12 weeks on ward, but its more watery. 2. Abdominal examination:- Uterus can not be felt per abdominally before 12 week.

3. PELVIC CHANGES- JACKQUEMIER’S OR CHADWICK'S SIGN:-It is the bluish coloration of the vestibule and the anterior vaginal wall. It is seen at 8th week of the pregnancy. Apart from these, vagina becomes soft and the secretion becomes more acidic. And also there is pulsation felt on the lateral fornices at 8th week called OSIANDERS SIGN. CERVICAL SIGNS-The cervix becomes soft and is called GOODELL’S SIGN. Apart from these bluish coloration of the cervix is visible.

UTERINE SIGNS-The uterus is enlarged to the size of the hens egg at 6th week ,size of the cricket ball at 8th week and the size of the fetal head by 12th week. It means after 12th week the uterus can be felt per abdomen.

INVESTIGATIONS :- TESTS USED ARE- Immunological test-Pregnancy test depends on the detection of the antigen (hCG) present in the maternal serum or the urine. TESTS USED ARE- Agglutination inhibition test Direct agglutination tests. Enzyme linked immunosorbent Assay ELISA In this hCG antiserum is added to the urine or blood. It is usually positive 14 days following missed period.

USG:- Gestational ring may be evident at 5th week, Fetal pole & yolk sac at 6th week, Cardiac pulsation at 7th week and Embryonic movements at 8th week.

SECOND TRIMESTER- SYMPTOMS:- Morning sickness and frequency of the micturation subsides while amenorrhea continue. The new features that appear are- Quickening denotes the feeling of the fetal movements by pregnant women. It is usually felt at 16-18th week in Primi gravida and 2 week earlier in multi gravida. Progressive enlargement of the abdomen. On the face Chloasma appears at 24thweek. Breast change become more evident. Colostrum become thick and yellowish at 16th week.

SIGNS:- Abdominal examination :- Inspection:-Line nigra and stria gravidarum may be seen. Palpation:- Fundal height is increased due to the progressive enlargement of the uterus. The height of the uterus is midway between the symphysis pubis and umbilicus at 16th week, at the level of the umbilicus at 24 week and at the junction between the lower 1/3rd & upper 2/3rd of the distance between umbilicus and xiphisternum at 28th week. Palpation of the fetal parts can be made at 20th week. Active fetal movements can also be felt at 20th week.

AUSCULTATION:- INVESTIGATIONS:- Fetal heart sound can be heard at 18-20 weeks. The fetal heart rate is 140beats/min (range 120-160/min). Sometimes uterine soufflé can be heard which is due to blood flow through uterine vessels (umbilical artery) and is synchronous with fetal heart sound.. INVESTIGATIONS:- USG at 18-20 wks for placental site, fetal anatomy and integrity of the cervical canal. Gestational age an be determined by bi-parietal diameter and femur length with variation of +-10 days.

THIRD TRIMESTER- SYMPTOMS:- Amenorrhea persists. Enlargement of the abdomen. Lightening-At 38th week specially Primi gravida a sense of relief of the pressure symptoms is obtained due decent of fetal head. Frequency of the micturation reappears. Fetal movements more pronounced.

SIGNS:- Cutaneous changes more prominent. Fundal height:- The distance between the umbilicus & xiphisternum is divided into 3 equal parts. The fundal height corresponds to the junction of the upper 1/3rd &lower 2/3rd at 32 weeks, Costal margin at 36 week. Up to level of the xiphisternum at 38 week At 40 week, 2 finger less than 38 weeks size due to engagement of the presenting part. Palpation of the fetal parts becomes easier.

FHS can be heard more distinctly. Fetal movements can be felt. Palpation of the fetal parts becomes easier. HOW TO CALCULATE? Expected date of delivery i.e. EDD- The women is asked for the date of the last menstrual cycle. Now from that date upto 9 months added and additional 7 days is added to get a EDD. This is called Naeggeles formula.