The Diagnosis of PregnancyThe Diagnosis of Pregnancy

Zhang Qingxue

Departmentment of ob & gyn

Sun yat-sen memorial hospital

Sun yat-sen university

The Whole Period of The Whole Period of Pregnancy Can Be Divided Into Pregnancy Can Be Divided Into

Three Stages:Three Stages: The first trimester (early pregnancy): 1-12w The second trimester (middle pregnancy): 13-

27 w The third trimester (late pregnancy): 28-40w

The Diagnosis of the First TrimesterThe Diagnosis of the First Trimester

1.History and symptoms

A. Cessation of menstruation

This is the first frequent symptom of pregnancy, although a few women may have slight bleeding after conception. But amenorrhea is not only due to pregnancy but also other reasons. Women of breast feeding may be pregnant before the recovery of menses.

1.The history and symptoms1.The history and symptoms

B. Nausea and vomiting

Also called morning sickness because they occur upon arising. These symptoms appear one or two weeks after the period is missed and last until 10th to 12th week, its severity varies from mild nausea to persistent vomiting (e.g. Hyperemesis gravidarum).

1.The history and symptoms1.The history and symptoms

C. Urinary symptoms

Increased frequency of urination is due to increased circulation associated with the effect of estrogen and progesterone on the bladder, combined with pressure by the gradually enlarged uterus on the bladder.

Internal genital organsInternal genital organs

1.The history and symptoms1.The history and symptoms

D. Mastodynia

It may be present in early pregnancy and ranges in severity from a tingling sensation to frank pain.

2. Signs2. Signs

Breast changes

Breast enlargement and vascular engorgement. Nipple and areola become blacker. Enlargement of the accumulated sebaceous glands of the areolas (Montgomery’s tubercles) may be noted.

Fig.20-1 Breast changes. Montgomery’s glands are prominent,and nipples and areolae are deeply pigmented. Accessory nipplebeneath left breast is also pigmented.

Changes of the reproductive organsChanges of the reproductive organs

Vagina: The vaginal wall become discoloration as the pelvic blood vessel becomes congested.

Cervix: Cyanosis and a gradual softening due to congestion.

Changes of the reproductive organsChanges of the reproductive organs

Uterus: enlargement and softening. The isthmus of the uterus is also soft and can be compressed between the fingers palpating vagina and abdomen (Hegar’s sign). After the 12th week, the fundus of the uterus is usually palpable above the symphysis pubis.

C. Supplementary examinationC. Supplementary examination

Pregnancy test

The laboratory test for pregnancy are based on the identification of human chorionic gonadotropin (hCG), which can be detected as early as 7-9 days after fertilization by high sensitive technique. The samples may be blood or urine.

Pregnancy testPregnancy test

Basal body temperature (BBT)Basal body temperature (BBT)

A persistent elevation of BBT for longer than 18 days may be presumptive evidence of pregnancy.

Progesterone testProgesterone test

Progesterone is given to a women with amenorrhea. If she is pregnant, no bleeding will follow, otherwise, bleeding should occur within 7-10 days of progesterone administration. This is reliable in the nonpregnant patient only if there is adequate estrogen stimulation of the endometrium.

cervical mucuscervical mucus

The cervical mucus smear of pregnant women shows a progestational effect—that is ellipsoid instead of fern crystallization.

cervical mucous 　　　　　　(1) type (Ⅰ ＋＋＋ ) ： typical fern crystallization (2) type (Ⅱ ＋＋ ) ： fern crystallization (3) type (Ⅲ ＋ ) ： atypical fern crystallization 　 (4) type (Ⅳ － ) ： ellipsoid

UltrasonographyUltrasonography

There are trans-vaginal and abdominal Ultrasonagraphys.

A gestational sac can usually be identified at 5-6 weeks after the beginning of the last period.

UltrasonographyUltrasonography

Fetal heart beating can be detected by about 7th week and the fetus itself can be seen by about the 8th week.

Doppler is also an ultrasound technique, which diagnoses the pregnancy by revealing the heart beating.

Picture of gestational sac

Picture of normal fetusa ． Pregnancy of 8w ； b ． Pregnancy of 18wBL-bladder ； UT-uterus ； GS-gestational sac

The diagnosis of the second and the The diagnosis of the second and the third trimester pregnancythird trimester pregnancy

SymptomsAbdominal enlargement and

fetal movement generally occurs after the 18th to 20th week of gestation.

SignsSigns

The uterus continues to enlargeFetal movement (quickening)

can usually be seen or heard after 18th week of gestation

Height of the uterine topHeight of the uterine top

xiphoid

SignsSigns

Fetal heart sound can be heard at rate varies from 120 to 160 beats per minute.

The fetal body can usually be palpated by the 18th to 20th week of gestation unless the patient is too fat, the abdomen is tender or there is an excessive amount of amniotic fluid.

Fetal heartFetal heart

Fetal heartFetal heart

(uterine souffle and umbilical souffle)

ballottement

Other ExaminationsOther Examinations

Ultrasonography.X-ray. It is rarely used recently beca

use the harmfulness to the fetus.Fetal electrocardiogram. A fetal elec

trocardiogram can first be recorded at about the 12th week of pregnancy.

Different methods of Different methods of pregnancy diagnosispregnancy diagnosis

Fetal lie & fetal PresentationFetal lie & fetal Presentation

Fetal lie: the relationship between the long axis of the mother and the long axis of the fetus. (longitudinal lie and transverse lie)

Fetal presentation: the portion of the fetus that descends into pelvis first.

fetal positionfetal position

Fetal position: the relationship of some guiding point of fetal presentation to a fined area of the maternal pelvis. (LOA, left occipital anterior)