The Diagnosis of Pregnancy

 

The diagnosis of pregnancy is based on certain symptoms and signs. It is sometimes difficult to make a sure diagnosis in the early months of pregnancy.

 

Diagnosis In The First Trimester

 

Symptoms:

 

1.      Amenorrhea:  Sudden cessation of previously regular menstruation is often the first indication that conception has occurred.

1Absence of menstruation may be due to conditions other than pregnancy.

2On the other hand, pregnancy may occur during a period of amenorrhea as lactation amenorrhea

1.      Morning Sickness: Nausea and vomiting are common symptom which usually starts in the early weeks of pregnancy and rarely lasts for more than three months.

2.      Easy fatigability, lassitude and sleepiness are fairly common.

3.      Emotional Changes: Craving for certain foods, odours and particular objects, and disinclination to others may also be present.

4.      Frequency and urgency of micturation: These are due to irritability of the bladder caused by pressure of the enlarged pregnant uterus and the congestion bladder mucosa. After the third month the symptoms become less severe and commonly disappear.

5.      Enlargement of the breasts: This is often noticed early in pregnancy There is increased heaviness, tingling sensation and there may be discomfort or actual pain in the breasts.

Signs

 

Ý.        Breast Sings:

1)      Increased size and sensitivity of the breasts and nipples.

2)      Increased vascularity and the appearance of subcutaneous veins.

3)      Dark pigmentation of the nipples and areola.

4)      Development of the second areola.

5)      Increased prominence of the tubercles of Montgomery.

6)      Secretion of colostrum.

 

ȝ.     Uterine Signs:

 

1)      The uterus becomes large in size, globular in shape and soft in consistence. By the end of the third month the fundus of the uterus can be felt just above the symphysis pubis.

2)      Palmers sign: Uterine contractions can be elicited by bimanual examination.

3)      Hegars sign: bimanual examination with two fingers in the anterior fornix and the fingers of the other hand on the abdomen behind the uterus, the internal and external fingers can be approximated due to the fact that the lower segment is soft and empty. The sign can be elicited between the 6th and 10th week of pregnancy, after which the sign becomes negative as the ovum has now filled the whole uterine cavity.

 

ʝ.    Cervical Signs:

 

The cervix is soft (Goodells sign), and shows a purplish or violet coloration (Chadwicks sign).

 

˝.    Vaginal and Vulval Signs:

 

The vulva and vagina are violet in colour, particularly the vestibule. The vagina becomes moist, warm and lax. There is increased acidity of the vaginal discharge.

Although none of the early clinical features of pregnancy is reliable yet they are very suggestive when taken collectively. In cases of doubt the diagnosis can be established with a high degree of accuracy by carrying out one of the pregnancy test.

 

Pregnancy Tests:

Ý.          

 

Diagnosis of Pregnancy In The Second Trimester

 

Ý.        Symptoms:

 

1The amenorrhea continues while the  morning sickness and the urinary symptoms either becomes less marked or completely disappear.

2The breast changes have become more obvious.

3Quickening which is the first perception of the fetal movements by the pregnant woman is usually experienced about the 16th week in the multipara and the 18th week in the primipara.

4From the fourth month onwards the patient notices the abdominal enlargement.

 

ȝ.     Signs:

 

1)      Abdominal Swelling.

1    The uterus is felt abdominally as an elastic median swelling with a convex upper border.

2    The gravid uterus undergoes contractions which are now evident on abdominal palpation (Braxton Hicks Contractions).

 

1)      Ballottement

1    Internal ballottement which is elicited bimanually is evident from the 16th week. Repercussion is felt when the fetus is given a push with two fingers in the anterior fornix.

2    External ballottement can be elicited from the abdomen as early as the 20th week.

1)      Palpation of the fetal parts and active fetal movements is experienced as early as the 20th week

1    This is a sure sign of pregnancy.

2    The detection of the fetal movements also indicates that the fetus is alive.

1)      Fetal heart sounds.

1  These are usually heard by the 24th week. Their presence is a sure sign of pregnancy

2    The rate of the fetal heart sounds is between 120 to 140 under normal conditions.

1)      Uterine Souffle

1    This is a soft blowing murmur synchronous with the maternal pulse. It is due to the rush of blood in the dilated uterine vessels.

1)      Umbilical or Funic Souffle.

1    It is due to the rush of blood in the umbilical arteries. It is only occasionally heard when the cord happens to be adjacent to the anterior wall of the uterus.

1)      The appearance of the stria gravidarum and the linea nigra which are evident in the second half of pregnancy.

 

 

 

 

Diagnosis of pregnancy In The Third Trimester

 

In the third trimester all signs of pregnancy have become more apparent and more convincing.

 

The Sure Signs of Pregnancy

 

1)      Active fetal movements detected by the obstetrician.

2)      palpation of the fetal parts.

3)      Auscultation of the fetal heart sounds.

4)      The occasional hearing of the umbilical souffle.

5)      Detection of the fetal skeleton by ultrasound.