DIAGNOSIS OF PREGNANCY

 DURATION OF PREGNANCY:-

10 Lunar Month

Or

9 Calendar Month And 7 Days

Or

280 Days 

Or 

40 Weeks

⦁ Diagnosis Of Pregnancy In 1st Trimester(0-12 Weeks):-

⦁ Amenorrhoea :- absence of menstrual cycle bleeding.

⦁ Morning Sickness :- In 50% pregnancy appear soon after the missed period and beyond the first trimester.

⦁ Increase frequency of micturition:- (8-12 Week) it disappear after 12 weeks

⦁ Fatique :- felling of fullness and pricking sensation

⦁ Breast discomfort:- seen At 6 To 8 week

⦁ Nipple & Areols(Primary) become more pigmented specially dark women.

→ Montgomery's tubercle are prominent (Secondary Areols-12w)

⦁ →Some time thick yellowish secration (Colostrum) can be expressed → 12 Weeks

⦁ Uterus remain a pelvic organ untill-12 weeks

⦁ Jacquarmier / Chadwick Sign:-

→Discoloration of the cervix & vagina 

→Dusky hue of the vestibule & vaginal wall(8 w)

⦁ Osiander Sign:- 

→Increase pulsation felt through the lateral fornics(8 w)

⦁ Goodells Sign:-

→ Softening of cervix 

→Cervix feels like lip of mouth (6w)

→In Non - Pregnant Feels Like Tip Of Nose 

⦁ Palmer's Sign:- Regular And Rhythmic Uterine Contraction Which Can Be Felt On Bimanual Examination (4-8 W)

⦁ Hegar's Sign :- 60-70 % Pragnancies.

Softening Of Uterus.

[On Bimanual Examination With 2 Fingers In Ant Fornix And Fingers Of Other Hand Behind The Uterus . The Abdominal Vaginal Fingers Seen To Appose Below The Body Of Uterus.]

⦁ Ladin's :- Softer The Utero - Cervical Junction (6w)

⦁ Mc Donald's Sign:- flexible Utero-Cervical Junction (7-8 W)

⦁ Von Fernwold Sign:- Softening Of Fundus (4-5 W)

⦁ Piskacek's Sign:- Asymmetric Enlargement Of Uterus If There Is Lateral Implantation Is Called Prskacek's Sign.

⦁ Uterine Change:- 

Size:- Size Of Hens Egg -6 Weeks

Size Of Cricket Boll - 8 Weeks 

Fetal Head Size-12 W

Shape:-        Puriform Shape Change In to Globular Shape By 12 Weeks.

Consistency:-  Soft And Elastic(Symettrical)

DIAGNOSIS OF PREGNANCY IN 2ND  TRIMESTER (13-28 W)

⦁ Subjective  Symptoms (nauses , vomiting & frequency of micturation) usually disappear but amenorrher continue.

⦁ quickening (18 week)

⦁ progressive enlargement of the lower abdomen by the growing uterus. 

⦁ chloasms-  pigmentation over fase head & check (24 w)

⦁ breast change- enlarge

appearance of secondary areola (20 w) 

montogmerys tubeercle.

colostrum becumes thick & yellowish( 26 w)

⦁ linea nigra(black line) & striae ( both pink & white)

⦁ inereased fundal height:

⦁ mid way between pubis symphysis & umbilicus -16 weeks

⦁ At the level of umbilicus -24 th week

⦁ at the junction of low 1/3 and upper 2/3 of distance between the umbilicus and ensiform cartilage - 28 weeks

⦁ at the ensitarm cartilage -36 weeks

⦁ 2-3cm lower then ensiform cartilage at 40th weeks

8. uterine changes:- 

⦁ uterus feel soft 

⦁ braxton -hicks contraction present(irregular,infrequent, sposmodic and painless without any effective cervix dilation)

⦁ palpation of fetal part- 20 weeks on wards

⦁ external ballotement-20 weeks on wards

⦁ compress one handin abdemen - fetus go to other hand on abdemen.

9. fetal heart sound (FHS):-

⦁ most consclusive clinical sign of pregnancy (pinards stethoscope )

10. vaginal &cervix changes:-

⦁ bluish discolorstion of vulva , vegins &cervix .

11. Internal ballotment:- 

⦁ between - 16 to 28th week. 

⦁ bimanual examination to fetus apposite side .

12. sonography (USG):- 

⦁ gestational age can be determined by biparietal diameter (BPD).

DIAGNOSIS OF PREGNANCY IN 3rd TRIMESTER OF PREGNANCY

1. AMENORRHEA

2. ENLARGEMENT OF THE ABDOMEN :- 

⦁ LEADS TO PALPITATION & DYSPNOEA

3. LIGHTENING :-

⦁ About 38 week

⦁ relif of pressure symptoms due to engagement of presenting part.

4. FREQUENCY OF MICTURATION REAPPEAR

5. FETAL MOVEMENT ARE MORE PROUNCED

6. CUTANEOUS CHANGE - MORE PROMINANT PIGMENTATION AND STRISE

7. UTERINE SHAPE - BECOMES SPERICAL FROM CYLINDRICAL OVAL

8. SYMPHYSIS FOUNDED HEIGHT:-

After 24 weeks SFS measured in upto 36(SFS weeks  +/- 2cm) normal.

9. braxton:- hicks contraction are more evident.

10. fetal movement are easily felt.

11. FSH are more clear & loud.

12. Palpation of the fetal parts and their identication becomes much easrie,lie presentation and position of the fetus.

13. sonography:-  geatational age estimation by BPD,HC, AC,CR2,OFD,F2

sonography:-

gestaional age estimation by

BPD→ (Bi-parietal diameter) 

HC  →  femur or fetus length

FL  →   Femur Or Fetus Length

CRL→  Crown rump length(more accurate acrose the axis) [LHL} CROWN HEAL LENGTH 

OFD→ ocupita frontal dismeter.

AC  → abdomen circumfersnce

→  Amnuiotic fluid volme assessment

→ location thickness and other abnormalities of placenta

Different dirgnosis of pregnancy:-

⦁ Psaudocyesis or phantom or spurious or false pregnancy:-

it is psychological disorder where the woman has the false

⦁ cystic overian tumer → over are liquid filled cysts that devda from cell on the surface of your overy.

⦁ Fibroid → tumors in the vterus →pelvic pain

→ab. normal vaginal bleeding 

→pressure on the bladder

⦁ distended urinary bladder:- A large bowel obstruction 

⦁ peritonitis(encysted):-

DOUBT

Pre- Sumptive symptoms:( true but not certain)

⦁ amenarrhoea

⦁ frequency of micturation 

⦁ morning sickness(nauses & vomiting)

⦁ fatigue

⦁ breast change (↑ size & ↑ felling of fullness)

⦁ skin change

⦁ quickening(perception of fetal movement by mother (16-18 w)

Probable signs:- (likely to be true)(maya be)

⦁ abdomen enlargement

⦁ braxton hicks contraction

⦁ external bollattement

⦁ increase size & shape & consistency of the uterus

⦁ chadwicks signs

⦁ goodell's signs

⦁ hegar sign osiander’s sign 

⦁ palmer sign

⦁ chadwick sign

⦁ piskack sign 

⦁ H.C.G

Positive signs:-

⦁ palpation of fetal parts and active fetal movement

⦁ auscultation of fetel heart sounds-dopplar- 10-12 w

-fetoscope- 20 w

⦁ ultra sound (6 w)

⦁ radiological (16 w)