Diagnosis Of Pregnancy

DIAGNOSIS OF PREGNANCY: DEFINITION Women may suspect pregnancy when they miss a menstrual period and she feels different .Changes in the breasts can occur as early as 5 to 6 weeks after conception. A correct date for the last menstrual period (LMP) and for the date of intercourse and a basal body temperature (BBT) record may be of great valve in the accurate diagnosis of pregnancy. DIAGNOSIS OF PREGNANCY: In the first trimester and early second trimester, is based on a combination of presumptive and a probable sign of pregnancy.Pregnancy is self-evident later in gestation when the positive signs of pregnancy are readily observed. Presumptive signs of pregnancy of pregnancy are maternal physiological changes, which the women experiences and which, in most cases, indicate to her that she is pregnant.  Amenorrhoea  Nausea and vomiting(morning sickness) from 4th -14th week  Tingling, tenseness, nodularity and enlargement of the nipples around 3rd to 4th week.  Increased frequency of micturition around 6th to 4th week.  Fatigue  Colour changes of breasts i.e. darkening of the nipples and primary and secondary areolar change.  Appearance of Montgomery’s tubercles.  Continued elevation of BBT in the absence of an infection.  Expression of colostrums from nipple  Excessive salivation  Quickening  Skin pigmentation and conditions such as chloasma,breast and abdominal striae and linen nigra Probable signs of pregnancy are maternal physiological changes other than presumptive signs, which are

detected upon examination and documented by the examiner  Enlargement of the uterus  Change in shape of the uterus  Presence of human chronic gonadotrophin in blood(4th to 12th) and in urine (6th to 12th )–positive pregnancy tests  Hegar’s sign(the softening and compressibility of the uterine isthmus between the 6th and 12th weeks of pregnancy)  Jacquemier’s sign/chadwicks sign and osianders sign  Palpation of Braxton Hick’s contractions  Balloatment of foetus Positive signs are those directly attributable to the foetus as detected and documented by the examiner.  Visualization of foetus by ultrasound(6 week+)  Visualization of foetus skeleton by x-ray(16 week)  Foetal heart sounds by ultrasound  Foetal heart sounds with fetoscope(20 week)  Palpable foetal movements(22th week)  Visible foetal movements  Palpation of foetal parts UTERINE ENLARGEMENT Estrogen and progesterone are responsible for the hypertrophy of the uterine wall during the early months of pregnancy. Uterine enlargement is the result of a considerable increase in the size and stretching of the muscle cells. After the third month of pregnancy the uterine enlargement is also due to the mechanical effect of inside pressure on the uterine wall by the growing products of conception. The resulting vascularity, congestion and edema most likely account for the overall softening of the uterus.This along with hypertrophy of the cervical glands, give rise to chadwick’s/Jacquemier’s sign and Hegar’s sign.

The softness and compressibility of the uterine isthmus (Hegar’s sign) has the effects of non-support to the enlarging body of the uterus with its increasing heaviness in the fundus.While the uterus is still a pelvic organ and causes the fundus to press on the bladder resulting in urinary frequency. Uterine enlargement contributes to two other maternal signs of pregnancy-the Braxton Hicks contractions and abdominal enlargement. Braxton Hick’s contractions are nonrhythmic,sporadic,painless uterine contractions that start about the sixth week of pregnancy. Abdominal enlargement begins at the fourth month of pregnancy, as the uterus becomes an abdominal organ. The abdomen is more prominent when the women is standing than when she is supine.It is noticeable in multipara than in primigravidas, because of the loss of muscle tone of the abdominal wall,which was not exercised back into shape after each previous pregnancy. FETAL CONTRIBUTIONS TO THE DIAGNOSIS OF PREGNANCY The foetal heart starts beating at the sixth week and can be heard by 20th week with a fetoscope during abdominal examination of the mother. However, it can be heard between 12th and 20th week with ultrasonic instruments. Fetal heart tones must be differentiated from two other sound(1) The uterine soufflé-a soft blowing and systolic murmur heard low down at the sides of the uterus, best on the left side. The sound is due to increase in blood flow through the dilated uterine vessels and is synchronous with the maternal pulse. (2) The funic soufflé-the sound of blood rushing through the umbilical arteries. It is a soft blowing murmur synchronous with the foetal heart sounds HORMONAL PREGNANCY TESTS

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Pregnancy tests are based on the production of chorionic gonadotrophin by the syncytiotrophoblastic cells during early pregnancy. Human chorionic gonadotrophin (HCG) is secreted into the maternal bloodstream where it is present in the plasma. It is then excreted in the mother’s urine. These tests have been largely superseded by the immunologic assays of HCG.The immunologic assays of HCG test utilizes specific antisera, obtained from animals (rabbits) in which antibody response to HCG has been stimulated. It is based on the fact that HCG is a protein and therefore antigenic. The antisera are mixed with urine of the women suspected of being pregnant.

SUBMITTED TO: MS SUBHASHINI G HOD OBG NURSING DEPARTMENT P.I.O.N

SUBMITTED BY: MS DIMSEY.R MARAK MSC NURSING 1ST YEAR P.I.O.N