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DIAGNOSIS OF PREGNANCY

FIRST TRIMESTER ( 1 12WEEKS )


Amenorrhoea ( Placental Sign ) Morning sickness Frequency of micturition Breast discomfort Fatigue

Objective Signs
Breast Changes Per Abdomen Pelvic Changes Jacquemier's or Chadwick's sign Vaginal sign Osianders Sign Cervical signs ( Goodells sign )

UTERINE SIGNS: * Size: - 6th week - size of a hen`s egg


- 8th week - size of a cricket ball - 12th week - size of a fetal head

* Shape - Non pregnant uterus - pyriform shape


- 12 weeks - globular - 6 8 weeks - anteverted position

* Consistency
- Piskacek's sign

Hegar's sign:

IMMUNOLOGICAL TESTS
PREGNANT
Urine (containing HCG) + HCG antiserum

Neutralisation of the antibody +

HCG coated latex particles

No Visible Agglutination

NON - PREGNANT Urine ( No HCG) + HCG antiserum

HCG antibody not neutralised + HCG coated latex particles Visible Agglutination

Immuno Assays Without Radioisotopes


Agglutination inhibition tests ( Latex test )
Direct latex agglutination test ( hCG direct test) Enzyme-Linked ImmunosorbentAssay (ELISA) Fluoroimmuno assay (FIA) Two site sandwich immunoassay ( membrane elisa / card tests )

Immuno assays with radioisotopes


Radioimmunoassay (RIA)
Immuno-radiometric assay (IRMA)

Uses of pregnancy tests


Diagnosis of uterine pregnancy Diagnosis of ectopic pregnancy To monitor pregnancy following in-vitro fertilisation and embryo transfer To follow up cases of hydatidiform mole and choriocarcinoma Test accuracy ranges from 98.6 - 99% Non-pregnant level is below l mlU / ml.

ULTRA SONOGRAPHY
Gestational sac and yolk sac --- 5 menstrual weeks Fetal pole and cardiac activity --- 6 weeks Embryonic movements --- 7 weeks Fetal gestational --- measuring the CRL between 7 and 12 weeks (5 days) Fetal heart rate --- l0th week

SECOND TRIMESTER ( 13 28 WEEKS )


Chloasma Breast changes Abdominal Examination Inspection Palpation

External and internal ballotment

Auscultation * FHS * Uterine souffl * Funic or fetal souffl Vaginal Examination * Internal ballottement

Investigations
* Sonography

LAST TRIMESTER ( 29 - 40 WEEKS )


Symptoms Signs Fundal height : * The distance between the umbilicus and the
ensiform cartilage is divided into three equal parts. * 32 weeks - corresponds to the junction of the upper and middle third * 36th week up to the level of ensiform cartilage * 40th week - comes down to 32 week level at 40th week

SUMMARY OF DIAGNOSIS OF PREGNANCY


Positive or absolute signs:

Palpation of fetal parts and perception of active fetal


movements by 20th week Auscultation of fetal heart sounds Ultrasound evidence of embryo by 6th week and later of fetus X ray shows the fetal skeleton at 16th week and onwards

Persumptive Symptoms and signs


Amenorrhoea Frequency of micturition Morning sickness Fatigue Breast changes Skin changes Quickening

Probable signs
Abdominal enlargement Braxton-Hicks contractions External ballottement Outlining the fetus Changes in the size, shape and consistency of the uterus Jacquemier's sign Softening of the cervix Osiander's sign Internal ballottement

Immunological test

DIFFERENTIAL DIAGNOSISOF PREGNANCY


Pseudocyesis (Syn: Phantom, spurious, false pregnancy) Cystic ovarian tumour Fibroid Encysted peritonitis Distended urinary bladder

Estimation of gestational age and prediction of expected date of delivery


Date of fruitful coitus Naegele's formula Date of quickening Previous records

Objective Signs
Sonography X-ray

Estimation of fetal weight


Fetal growth velocity Johnson's formula : Sonography: * Shepard's formula: * Hadlock's formula

Thank You

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