Diagnosis Of Early Pregnancy

Diagnosis of early Pregnancy Lecturer Liu Wenhui Sophie liu The Department of Gynecology & Obstetrics in Zhongnan Hospital

Contents Intruction Manifestions of early pregnancy Helpful examinations of early pregnancy Differential diagnosis of early pregnancy

Objectives Master the Definition of pregnancy Master the Manifestions of early pregnancy Master pregnancy test and other helpful examinations especially ultrasonography

Case Name : Mary Sex:Female Age :30 Occupation:Teacher She has married for one year,now She has following symptoms:cessation of menstruation,nausea and vomiting,urinary frequency and urgency; She has following signs: enlargement of uterus,softening of the cervix, softening of the cervicouterine junction Which problem has she ?How can you help her?

Introduction

Sexual reproduction is the union of the nuclei of the female sex cell (ovum) and the male sex cell (sperm cell) that results in the creation of a new individual

Pregnancy Definition: Growth and developmental process in a women from fertilization through embryonic and fetal period to birth;gestation or conception

Sexual reproduction is the union of the nuclei of the female sex cell (ovum) and the male sex cell (sperm cell) that results in the creation of a new individual

From now on

末次月经 (LMP) 预产期 (EDC) Early pregnancy

The third trimester 晚期妊娠

27 周 末

早期妊娠

12 周 末

The second trimester 中期妊娠

妊娠全过程为 40 周（ 280 天） , 分 三

How to Diagnose the early Pregnancy ?

Manifestations of early Pregnancy

A.Symputoms Amenorrhea :no menstruation flow or cessation of menstruation (The cyclical loss of sanguineous fluid from the uterus in mature women. The usually duration of the menstrual cycle is 3-5 days. The average amount of blood lost is 30-80ml)

10 days or more after the time of expected onset of the menstrual period

Nausea with or without vomiting(morning sickness) Nausea is an unpleasant sensation in the stomach and a tendency to vomit

Urinary frequency and urgency Begins about 6th week ,and disappears about 12th week

2-cell stage Morula 桑葚胚 Blastocyst 囊胚

day 7

Implanting blastocyst 囊胚植入 Endometrium 子宫内膜

hCG

The breast:

Accessary Organ of Reproduction

2nd development ,1st is in adolesence Pain slightly

Attention other symputoms!

Uterine bleeding: this may be related to inbed or implantation Conception may occur without prior menstruation before menarche Nursing mother may become pregnant during lactation

B.Signs Breast changes (enlargement, Montgomery) Montgomery

Hegar’s sign: softening of the cervix, softening of the cervicouterine junction (Bimanual palpation 双合诊 )

other Examinations

Clinical test Pregnancy test

2-cell stage Morula 桑葚胚 Blastocyst 囊胚 Implanting blastocyst 囊胚植入 Endometrium 子宫内膜

day 7

hCG

Be detected in plasma or urine by 8-9 days after ovulation

着床前后 HCG 的变 化

Blood or urine test to detect the presence of HCG Get a peak at about 8 to 10 weeks Then declines slowly and maintains low level at about 100 to 130 days until delivery

Steps :

Pelvic ultrasonography

A.35day

all sac visible

B.42day all heart beat detectable

5wk Embryo and Yolk Sac

7wk Embryo and Yolk Sac

asal body temperature （ BBT ） ： A small increase in body temperature during the luteal phase of the menstrual cycle last over 3 weeks

Pregestin test Use of pregestin 20mg every day for three or five days Withdrawal of pregestin Within 7 days may bleeding or not (pregnant)

Cervical mucus examination steps Celluar appearance

Celluar appearance

Palm leaf pattern

Differential diagnosis of pregnancy

Myomas(fibroids) Belign tumor in the uterus Changes of menstruation Very firm and irregular (Bimanual palpation 双合 诊) Pregnancy test is negative No embyro in the uterine cavity

Ovarian tumor Pregnancy test is negative No embyro in the uterine cavity Found midline ,displacing the nonpregnant uterus to the side or posteriorly

Ectopic pregnancy

1.Pregnancy test is positive 2.No embyro in the uterine cavity

!!:90%of ectopic pregnancy

occur in the fallopian tubes(tubal pregnancy),rupture of the ectopic pregnancy within the fallopian tube can lead to massive hematosapinx. Surgeons remove the implant and preserve the fallopian tube before rupture occurs. Laproscopy

Questions ?

True or false If a women fells nausea and vomitong ,she is pregnant . A pregnant women”s LMP is 12/92007,her EDC is 7/9-2008. HcG levels double approxiamately every 72 houys in early pregnancy. The uterus is enlarged ,the women is pregnant.

Which manifestions are there in early pregnancy? Which examinations are helpful to diagnose early pregnancy?

Early pregnancy

The second trimester and the third trimester

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