Diagnosis Of Second And The Third Trimester

The Diagnosis of the second and third Trimester of pregnancy Lecturer: Liu Wenhui Sophie liu The Department of Gynecology & Obstetrics in Zhongnan Hospital

Contents Intruction Manifestions of the second and third trimester of pregnancy Helpful examinations of the second and third trimester of pregnancy Differential diagnosis of the second and third trimester of pregnancy Fetal position ,Fetal presentation,Fetal lie

Objectives Master the Symputoms and the presumptive and positive Signs of the second and third trimester of pregnancy Master helpful examinations Master Fetal position,Fetal presentation and Fetal lie

Introduction

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

Early pregnancy

The second trimester and the third trimester of pregnancy

The female reproductive system consists of organs that provide a place for the growth of the embryo and the fetal

Manifestations of the second and third trimester of pregnancy

A.Symputoms Amenorrhea :no menstruation flow or cessation of menstruation

Disturbance in urination 1.Begins about 6th

week ,and disappears

about 12th week 2.Reappears near the end of pregnancy

Perception of fetal movement Slight fluttering movements in the abdomon, increase in intensity(Quickening Noted about at 18th week A milestone of the progress of pregnancy Provide corroborative evidence in establishing the duration of gestation

B.Presumptive Signs Breast changes (enlargement, lactating in late pregnancy)

Discoloration of the vaginal mucosa Dark bluish or purplish –red and congested (Chadwick sign) Not conductive

Increased skin pigmentation and appearance of abdominal striae Not diagnostic of pregnancy With the ingestion of estrogen –pregestin contraceptives too

C.Probable evidence of pregnancy Enlargement of the abdomen From 12th week ,the uterus gradually increases in size until the end of the pregnancy

Changes in size,shape ,and consistency of the uterus An average uterine diameter of 8cm is attained by 12 weeks The body of the uterus is almost globular

Braxton Hicks Contraction Painles contractions at irregular intervals Increase in number and amplitude when the uterus is messaged In the last few days of pregnancy ,the frequency may increase ,preparedness for labor

Ballotement near Midpregnancy

Outline of the fetus

Method of abdominal palpation to determine fetal lie and location of back

Method of abdominal palpation to determine presentation part

Attention:Positive signs of pregnancy Fetal heart action Fetal movement by sonography Recongnition of the fetal in the uterus cavity by sonography

Fetal heart action a.120bpm-160bpm b.as a double sound resembling the tick of a watch under a pillow

正常

快音

快音

快音

慢音

NST

OCT

ATTENTION ! The umblical cord souffle The uterine souffle Sounds from the fetal movement Maternal pulse Gurgling sounds produced by gas or liquid propulsion through the maternal intestine

Helpful Examinations

Clinical test Pregnancy test

Get a peak at about 8 to 10 weeks Then declines slowly and maintains low level at about 100 to 130 days until delivery

Ultrasonography

Detect FHR accurantly, monitoring the baby, Excluding teratogens(malformation), Diagnose Twins and so on, Abnormal placenta and aminofluid

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 fetal in the uterine cavity

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

Other examinations

fetal lie ： relationship between the long axis of the fetus and the long axis of the uterus longitudinal lie( 纵产式 )99.75%

transverse lie( 横产式 )0.25%

shoulder presentation

fetal presentation : the fetus part which is presented to the pelvis. Different fetal lies have different presentation, for example: longitudinal lie has head or breech presentation

头先露因胎头屈伸程度不同有四种先露 Head presentation has 4 different attitudes

occiput

bregma

brow

face(mentum)

breech presentation

Complete breech

Frank breech

Footling breech

fetal position ： The relationship between denominator of fetus presentation and maternal pelvic Presentation:

Denominator:

Flexed head Face breech

Occiput Mentum(chin) sacrum

LOA (left occipito-anterior)

ROA (right occipito-anterior)

LOT(left occipito-transverse)

ROT(right occipito-transverse)

LOP(left occipito-posterior)

ROP(right occipito-posterior)

Questions ?

Give the meanings of the following terms NST OCT Fetal position Fetal presentation Fetal lie

Quickening

Which manifestions are there in the second and third trimester of pregnancy ? Which examinations are helpful to diagnose the second and third trimester of pregnancy?

References F.Gary ,Norman F.Gant,et.al Williams Obstetrics, 21th Edition, 20-30 Alan H. Decherney , Martin L. Pernoll,Current Obstetrics &Gynecologic Diagnosis &Treatment,66-70

r u o y r o f u o y k Than ! n o i t n atte

Combining Forms Combining Form amni/o

meaning amnion

Terminology Meaning amniocentesis amniotic fluid Produced by fetal membranes and the fetus. cervic/o cervix,neck endocervicitis chori/o chorion choriogenesis chorion/o chorionic colp/o vagina colporrhaphy colposcopy culd/o cul-de-sac culdocentesis Placement of a needle through the posterior wall of the vagina with withdrawal of fluid for diagnostic purposes.

Combining Form

men/o

meaning

menses,

Terminology

Meaning

amenorrhea

menstruation Absence of menses for 6 months or for longer than 3 of the patient’s normal menstrual cycles. dysmenorrhea oligomenorrhea Infrequent or scanty menstrual periods. menorrhagia Abnormally heavy or long menstrual periods. Fibroids are a leading causes of menorrhagia.

Combining Form metr/o metri/o menstruation.

meaning Terminology Meaning uterus metrorrhagia Uterine bleeding other than caused by menometrorrhagia

periods. my/o myom/o

nat/i obstetr/o

Excessive uterine bleeding at and between menstrual

muscle muscle tumor

endometriosis myometrium myomectomy

Removal of fibroids from the uterus. birth neonatal The first 4 weeks of life after birth. midwife obstetric

Combining Form meaning Terminology ov/o egg ovum

Meaning

ovari/o salping/o

ovary ovarian fallopian tubes salpingectomy

uter/o

uterus

uterine prolapse

vagin/o

vagina

vaginal orifice

Orifice means opening. Vaginitis Bacteria and yeast (Candida) commonly cause this infection. vulv/o

vulva

vulvovaginitis

Suffixes Suffix -arche

Meaning Terminology Meaning beginning menarche

-gravida pregnancy

primigravida

A woman during her first pregnancy (primi-means first). Gravida is also used as a noun to describe a pregnancy woman, and it may be followed by numbers to indicate the number of pregnancies(gravida 1,2,3)

Suffix

-parous

Meaning

to bear,bring

Terminology

Meaning

primiparous

forth An adjective describing a woman who has borne (delivered )at least one child. Para is also used as a noun and may be followed by numbers to indicate the number of deliveries after the 20th week of gestation (para 1,2,3). -rrhea discharge leucorrhea This nonbloody vaginal discharge may be mucoid or purulent (containing pus) and a sign of infection or cervicitis. menorrhea -tocia

labor,birth

dystocia oxytocia Oxy-means rapid.