Diagnosis Of Pregnancy
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DIAGNOSIS OF PREGNANCY History Physical examination Investigations Differential diagnosis
HISTORY AMENORRHOEA – stress/emotional upset, lactation, contraceptive pill, hormonal (ovarian-pituitary) imbalance BREAST CHANGES – Increase in size, heaviness/pain in the breasts FREQUENCY OF MICTURITION – initially due to increased vascularity & pressure from the enlarging uterus but later due to pressure from the fetal head on the bladder. MORNING SICKNESS – gastric upset ranging from anorexia to nausea and repeated vomiting especially in the morning (usually from the 6th to 14th Wk). Attributed to hCG levels due to higher incidence in multiple pregnancy/molar pregnancies. Severe form →hyperemesis gravidarum PTYALISM ABDOMINAL ENLARGEMENT – may initially be due to slight intestinal distension before the uterine enlargement becomes evident. Consider 5F’s. QUICKENING – Fetal movement may be slight initially and confused with wind in the intestine. It is first noticed at about the 16th Wk for multipara & 18th – 20th Wk for primigravida. In pseudocyesis, the patient convinces herself of its’ presence.
PHYSICAL EXAMINATION SKIN CHANGES – pigmentation of the face & areola (10 & 20) of the breasts; Montgomery’s tubercles (prominent sebaceous glands as pink red nodules on the areola) PROGRESSIVE ENLARGEMENT OF THE UTERUS PAINLESS UTERINE CONTRACTIONS (can be felt even in a pelvic uterus with a co-operative patient) BALLOTTEMENT – internal (14 Wks) & external (24Wks) Palpation of FETAL PARTS(24-26Wks) & FETAL MOVEMENT (20Wks) FETAL HEART SOUNDS (24th Wk), uterine soufflé (20th Wk) & funic soufflé (umbilical cord blood flow) JACQUEMIERS SIGN – darkening of vaginal skin (8Wks) HEGARS SIGN – softening of the lowest part of the body of the uterus (8 Wks) OSIANDERS SIGN – increased pulsation in the lateral fornices (8Wks) SOFTENING & BLUE DISCOLORATION OF THE CERVIX (complete by the 16th Wk)
INVESTIGATIONS Tests on maternal urine – immunochemical tests Tests on maternal plasma/serum – radioimmunoassays & enzyme-linked immunosorbent assays (ELISA) Ultrasonography – Abdominal & transvaginal, sonicaid (10Wks) Abdominal X-rays
DIFFERENTIAL DIAGNOSIS Uterine fibroids Ovarian cysts Distended bladder Pregnancy associated with uterine fibroids/ovarian cysts Pseudocyesis
HISTORY AMENORRHOEA – stress/emotional upset, lactation, contraceptive pill, hormonal (ovarian-pituitary) imbalance BREAST CHANGES – Increase in size, heaviness/pain in the breasts FREQUENCY OF MICTURITION – initially due to increased vascularity & pressure from the enlarging uterus but later due to pressure from the fetal head on the bladder. MORNING SICKNESS – gastric upset ranging from anorexia to nausea and repeated vomiting especially in the morning (usually from the 6th to 14th Wk). Attributed to hCG levels due to higher incidence in multiple pregnancy/molar pregnancies. Severe form →hyperemesis gravidarum PTYALISM ABDOMINAL ENLARGEMENT – may initially be due to slight intestinal distension before the uterine enlargement becomes evident. Consider 5F’s. QUICKENING – Fetal movement may be slight initially and confused with wind in the intestine. It is first noticed at about the 16th Wk for multipara & 18th – 20th Wk for primigravida. In pseudocyesis, the patient convinces herself of its’ presence.
PHYSICAL EXAMINATION SKIN CHANGES – pigmentation of the face & areola (10 & 20) of the breasts; Montgomery’s tubercles (prominent sebaceous glands as pink red nodules on the areola) PROGRESSIVE ENLARGEMENT OF THE UTERUS PAINLESS UTERINE CONTRACTIONS (can be felt even in a pelvic uterus with a co-operative patient) BALLOTTEMENT – internal (14 Wks) & external (24Wks) Palpation of FETAL PARTS(24-26Wks) & FETAL MOVEMENT (20Wks) FETAL HEART SOUNDS (24th Wk), uterine soufflé (20th Wk) & funic soufflé (umbilical cord blood flow) JACQUEMIERS SIGN – darkening of vaginal skin (8Wks) HEGARS SIGN – softening of the lowest part of the body of the uterus (8 Wks) OSIANDERS SIGN – increased pulsation in the lateral fornices (8Wks) SOFTENING & BLUE DISCOLORATION OF THE CERVIX (complete by the 16th Wk)
INVESTIGATIONS Tests on maternal urine – immunochemical tests Tests on maternal plasma/serum – radioimmunoassays & enzyme-linked immunosorbent assays (ELISA) Ultrasonography – Abdominal & transvaginal, sonicaid (10Wks) Abdominal X-rays
DIFFERENTIAL DIAGNOSIS Uterine fibroids Ovarian cysts Distended bladder Pregnancy associated with uterine fibroids/ovarian cysts Pseudocyesis
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