Kuliah Sem4 2008-3

Fakulti Kejururawatan

Diagnosis Of Pregnancy & Normal Pregnancy By Nor Marini Ibrahim

Diagnosis Of Pregnancy Objectives: On completion of this topic, the student will be able to do the following:  Differentiate among the presumptive, probable and positive signs of pregnancy.

Diagnosis Of Pregnancy 

Presumptive symptoms Amenorrhea - Cessation of menses, often the first sign of pregnancy Nausea & vomiting - these symptoms are noticed early in the pregnancy. Usually begins early in the day and lasts for several hours.

Diagnosis Of Pregnancy

Presumptive symptoms..cont - Caused by elevated levels of human chorionic gonadotropin (HCG) and altered carbohydrate metabolism & usually subside by 12 weeks of pregnancy. 

- Excessive nausea and vomiting (hyperemesis gravidarum) can result in dehyration, weight loss, electrolyte imbalance and the need for hospitalization

Presumptive symptoms..cont

Breast sensitivity - In early pregnancy, woman noticed increased breast sensitivity & complain of tenderness and tingling in the breast. - Breast enlargement and nodularity are evident as early as the 2nd month of pregnancy. - Nipples & areolar enlarge & become more deeply pigmented. - These changes are caused by hormoninduced growth of secretory ductal system in the breast.

Presumptive symptoms..cont Urinary symptom - This disturbances in urination, particulary frequency, occur in early pregnancy (1st trimester) and are caused by pressure of the enlarging uterus uterus on the bladder. Condition will improves as the uterus grows and moves up into the abdomen but returns late in pregnancy when the fetal head settles into the pelvis against the bladder.

Presumptive symptoms..cont Fatigue - Tiredness is often experience by some women very early after conception and is one of the earliest symptom of pregnancy caused by many hormonal changes. Usually persists into 2nd trimester with the women getting back to normal by the 16th to 18th week.

Quickening - women feels slight, fluttery movements of fetus at about 18-20 weeks of gestation

Probable signs (strongly indicate pregnancy)

Abdominal enlargement - By the end of the 12th week of pregnancy, uterus can felt above the symphysis pubis. By the 20th week, uterus should be at the level of the umbilicus. Uterine & cervical changes - uterus enlarge and softens early in pregnancy at about 6 weeks gestation

Probable signs (strongly indicate pregnancy) -

Softening of the cervix and vagina (Goodell’s sign)

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Softening of the the lower uterine segment or isthmus (Hegar’s sign)

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Cervix has a bluish colour within the first 6-8 weeks of pregnancy. (chadwick’s sign)

Probable signs (strongly indicate pregnancy)

Pregnancy test - based on the ability to detect human chorionic gonadotropin (hCG) levels in maternal plasma & urine - presence of hormon hCG in the maternal blood or urine (6 to 9 days after a missed period)

Positive sign (confirm pregnancy) Identification of fetal heart beat - diagnosis of pregnancy is confirmed with heart beat, which ranges from 110160 beat per minute - fetal heart tone can be identified at 12- 14 weeks by an ultrasound fetal heart monitoring and auscultation with a fetal stethoscope

Positive sign (confirm pregnancy) Ultrasonographic recognition of the fetus – small, white gestational ring can be seen by vaginal ultrasound probes after 5 weeks of amenorrhea & - abdominal ultrasound after 6 weeks of amenorrhea. Fetal parts can be seen at 8 weeks’ gestation.

Positive sign (confirm pregnancy) Fetal movement observed or palpated through the abdominal wall . This objective evaluation of fetal movement can be made around 16-20 weeks gestation.

Dating the pregnancy  

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Good Dates Reliable last menstrual period (LMP) Documented positive pregnancy test by 6 weeks 1st antenatal examination before 12 weeks Fetal heart tone’s by Droppler @ 10th weeks Poor dates Unknown LMP

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Calculating of due date - The due date has been called the estimation date of delivery (EDD) - Length of pregnancy: i. full term = 38-42 weeks ii. Premature = < 38 weeks iii. Post term = > 42 weeks

 Nagele’s Rule - The most common method of determining the EDD - To calculate of EDD it is helpful to know the date of last menstrual period (LMP) - Begin with the first day of last menstural period (LMP), substract 3 months and add 7 days.

• Calculation – example: First day of LMP Substract 3 months months

= 20.10.2007 = 3 7 months

Add 7 day

+ 20 = 27 days

EDD

= 27. 7 . 2008

• Calculation – example: LMP : = ADD 7 days & 9 months

= substract 12 months = = EDD

= 27.7.2008

20.10.2007 = 7. 9.2007

27.19 12 27.7.2008

 Calculation of due date • Also can calculate by using the gestation calculator • Measures the height of the fundus

Thank You