Chapter 4 diagnosis of pregnancy phases ： ≤12w early phase phases ： ≤12w early phase 13w--27w middle phase 13w--27w middle phase ≥28w late phase ≥28w late phase sec.1 diagnosis of early phase sec.1 diagnosis of early phase sec.2 diagnosis of mid/late phase sec.2 diagnosis of mid/late phase n sec.3 lie,presentation and position

Sec.1 diagnosis of early phase [history and symptom] [history and symptom] 1.cessation of menses:in a healthy married woman who has previously menstruated regularly,cessation of menstruation strongly suggests the pregnancy.the date of expected period has been passed by 10 days or more,the likelihood of pregnancy is indicated.when the second period is also missed the probability naturally becomes stronger.but absence of menstruation may result from a number of conditions other than pregnancy,such as psychic influence,anemia and breast-feeding period. 1.cessation of menses:in a healthy married woman who has previously menstruated regularly,cessation of menstruation strongly suggests the pregnancy.the date of expected period has been passed by 10 days or more,the likelihood of pregnancy is indicated.when the second period is also missed the probability naturally becomes stronger.but absence of menstruation may result from a number of conditions other than pregnancy,such as psychic influence,anemia and breast-feeding period. 2.morning sickness:the establishment of pregnancy is frequently manifested by disturbances 2.morning sickness:the establishment of pregnancy is frequently manifested by disturbances

n Of the digestive system,the morning sickness usually comes in the early part of gestation,about the end of the first month and disappears 6 or 8 weeks later, although some patients suffer from it for a long period, that is “hyperemesis gravidarum”. n 3.urinary disturbance:in the early weeks the enlarging uterus by exerting pressure on the bladder may cause a desire for frequent micturition.this continues for the first months and gradually passes off as the uterus rises up into the abdomen,to reappear when the head descends into the pelvis a few weeks before delivery. 〔 physical exam. and signs 〕. n 1.breasts:enlargement,pigmentation of nipples and areola surrounded by Montgomery tubercles. n 2.reproductive tract.

n (1)coloration of the mucous membrane of vagina vulva. n (2)Hegar sign:on careful vaginal examination,the firm, hard cervix is felt and above it the elastic corpus, between the two the isthmus is felt as a soft compressible area.occasionally the change is so marked that as if no connection exists. Hegar signHegar sign n (3)enlargement of uterus:during the first two months the uterus continues to be entirely a pelvic organ, whereas during the third month it begins to rise above the symphysis into abdominal cavity. enlargement of uterusenlargement of uterus 〔 accessory exam. 〕 n 1.ultrasonography. n (1) B-us:as early as 5w,the gestational ring can be seen,with heart-beat and movement of fetus. B-us

n (2)Dopplar-us:as early as 7w,the fetal heart sound can be heard. Dopplar-us 2.gestational assay: 2.gestational assay: β-hcG≥25u/L in urine. 3.cervical discharge smear:ellipsoid. 4.progesterone assay:not in use. 5.basal temperature:with a cessation of menses,a higher level of temperature for 3w or more which will indicate the pregnancy.basal temperature 6.DD. Ovarian cyst,myoma,urine retention. Sec.2 diag. Of mid and late phases 〔 history and symptom 〕 :with the history of early phase ;the feeling of the enlargement of abdomen and movement of fetus. 〔 physical exax. and sign 〕

n 1.enlargement of uterus:relative height of the fundus at the various lunar months of pregnancy. enlargement of uterusenlargement of uterus n 2.fetal movement;from 5m,3-5t/min. n 3.fetal heart beat:from the 18th/20th m, bpm. n 4.fetal body:head,back,buttock,extremities..fetal body.fetal body 〔 accessory exam. 〕 1.B-us:of great importance for confirming the fetal position,the developing state,the site of placenta and the quantity of amniotic fluid. 2.fetal ECG:not in use.3. NST.NST. Sec.3 lie,presentation and position of fetus. ( 一 )fetal lie:the relation which the long axis of the fetus bears to that of the mother.we dis- -tinguish between longitudinal and transverse.fetal lie

n ( 二 )fetal presentation n DEF-:the part of the n fetus occupying the n lower pole of the ut- n -erus, n fetal position:the relation of some arbitrarily chosen portion of the fetus to the right/left side of the maternal pelvis.the occiput,chin,sacrum and scapular being the determining points in vertex,face,breech and shoulder presentations respectively. fetal positionfetal position Fetal lie Cephalicbreechshoulder Compound presentation

Hegar

B-ultrasonograghy for early phase

Basal temperature ovulation fertilization menstruation

Abdominal palpation

Presentation of fetus

Relative height of fundus at various lunar months of pregnancy

Vaginal touch

Fetal lie Longitudinal lie transverse

Cephalic presentation occipital vertex brow face

Breech presentation complete frank Single footling footling

Compound presentation

Post-fontanell Ante-fontanell BPD Sagittal suture parietal occipital Frontal suture Coronary suture 9.3cm

position LOALOP LOT ROA ROP ROT LSA LSP RSA RSP LMA LSP RMA RMP

transverseransverse LOAROA LSA RSA

Enlargement of uterus