By

Dr/Ayat Masoud Omar

The diagnosis of pregnancy requires a

3multifaceted approach using 3 main diagnostic

tools, history and physical examination,

hormonal assays, and ultrasound (US).

Currently, physicians may utilize all of these

tools to diagnose pregnancy at early gestation

and to help rule out other pathologies

• Presumptive (subjective )signs

•Objective (probable) signs

Diagnostic (positive/sure) signs of pregnancy

These signs are least indicative of

pregnancy; they could easily indicate

other conditions. signs lead a woman to

believe that she is pregnant

(1)Amenorrhea:It is the earliest symptoms of pregnancy. In

healthy women whose menstrual cycles are

regular, missing one or more menstrual

periods leads to consideration of pregnancy.

D.D( others )?

Are experienced by almost half of all pregnant women during the first three months of pregnancy and result from elevated HCG level .The symptoms frequently occur in the early part of the day, and disappear within few hours and commonly called Morning Sickness. These symptoms disappear spontaneously from 6 to 12 wks

(2) Nausea and Vomiting

3)Excessive fatigue:

May be noted within a few weeks after the

first missed menstrual period and may be

persisted throughout the first trimester.

• Is caused by pressure of the expanding uterus on the bladder.

• It subsides as pregnancy progresses and the uterus rises out of the pelvic cavity.

• The uterus returns during the last weeks of pregnancy as the head of the fetus presses against the bladder.

4)Engorgement of the breasts

due to the hormone-induced growth of the

secretary ductal system results in subjective

symptoms of tenderness and tingling,

especially of the nipple area.

Montgomery's tubercles: from 12-30

nodules appear on primary areola, opening

of sebaceous glands and keeps the nipple

soft.

 

Secondary areola: appears from 16

weeks, covering half of breast, persist

year after delivery.

 More prominent and visible veins due to

the increased blood supply.

5) Quickening:

It is the first perceptible fetal movement felt

by the pregnant mother, occurs about 18-20

wks after the last menstrual period in a

primigravida, but may occur as early as 16

wks. in a multigravida. Quickening is the

fluttering sensation in the abdomen that

gradually increases in intensity and frequency.

II-Objective (probable) signs:

An examiner can perceive the objective

changes that occur in pregnancy. They are

more diagnostic than the subjective

symptoms; however, their presence does not

offer a definite diagnosis of pregnancy.

Changes in the pelvic organs:

These changes caused by increased vascularity

and congestion during the first three months of

pregnancy.

1- Hegar's sign:

It is the softening of the isthmus of the

uterus, the area between the cervix and

body of the uterus, which occur at 6 to 8

weeks of pregnancy. This area may become

so soft that on bimanual examination the

anterior fornix fingers and abdominally

fingers meet each other.

2- Chadwick's sign:

Is the deep red to purple or bluish

coloration of the mucous membranes of

the cervix, vagina and vulva due to

vasocongestion of the pelvic vessels.

McDonald's sign :

It is an ease in flexing the body of the

uterus against the cervix.

Osiander's sign:

It is increase pulsation in lateral fornix

due to increase vascularity resulted in

pelvic congestion.

Enlargement of the abdomen:

During the childbearing years is usually

regarded as evidence of pregnancy,

especially if the enlargement is progressive

and is accompanied by a continuing

amenorrhea.

Braxton Hicks contractions:

Are ordinary painless that occur at

irregular intervals throughout pregnancy

but are felt with abdominal palpation after

28 weeks. As the pregnancy progresses

these contractions become uncomfortable

and are often called" false labor ".

 

Uterine Soufflé:

May be heard when auscultating the

abdomen over the uterus. It is a soft

blowing sound at the same rate as the

maternal pulse and is due to the

increased uterine vascularization and the

pulsation through the placenta.

 

Uterine soufflé is sometimes confused

with the funic soufflé which is a soft

blowing sound of blood pulsating through

the umbilical arteries. The funic soufflé is

as the same rate as the fetal heart rate

Skin changes: Changes as pigmentation of the skin and the

appearance of abdominal stria gravidarium are

common manifestation in pregnancy. Facial

cholasma occurs in varying degrees after 16

weeks. Also linea nigra also appear in the

abdomen. The pigmentation of the nipple and

areola may darken, especially in primigravidas.

- Fingernails. Some patients note marked thinning and

softening by the sixth week.

Ballottement:

Is a passive fetal movement elicited by

pushing up against the cervix with two

fingers. This pushes the fetal body up and

down as it falls back, the examiner feels a

rebound.

Pregnancy test: Are based on analysis of maternal blood or

urine for the detection of human chorionic

gonadotrophins(hcG). 

Pregnancy tests: All depend on the

detection of hCG either in urine or in serum. HCG levels peak between 50 to 90 days

after the last menstrual period.

Production of hCG begins as early as the day of implantation

(a) Urine. This test can be performed accurately 42

days after the last menstrual period or 2 weeks after the

first missed period. The first urine specimen of the

morning is the best one to use.

(b). Blood. Radioimmunoassays (RIA) can detect HCG

in the blood 2 days after implantation or 5 days before

the first menstrual period is missed.

III -Diagnostic (positive/sure) signs of

pregnancy

The positive signs of pregnancy are

completely objective, cannot be confused

with pathological states, and offer conclusive

proof of pregnancy, but they are usually not

present until after the fourth month of

pregnancy.

1-The fetal heart beats:

The fetal heart begins beating by the 24th day

following conception. It is audible with a doppler by

10 weeks of pregnancy and with a fetoscope after the

16th week . It is not to be confused with uterine

souffle or swishlike tone from pulsating uterine

arteries. The normal fetal heart rate is 120 to 160

beats.

2-Fetal movements:

Are actively palpable by a trained

examiner after about 20weeks of

gestation. They vary form a faint flutter in

the early months to more vigorous

movements late in pregnancy.

3-Ultra sound:

Is a technique that can be used for a

positive diagnosis as early as the fourth to

fifth week of pregnancy.

The earliest structure identified is the

gestational sac (GS). The GS can be seen on

TVUS by 4-5 weeks' gestation and grows at

a rate of 1 mm/d in early gestation

4-Fetal Parts:

Can be palpated through the abdominal wall

5-Radiological (x-ray):

An x-ray will identify the entire fetal skeleton

by the 12th week. In utero, the fetus receives

total body radiation that may lead to genetic

or gonadal alterations. An x-ray is not a

recommended test for identifying pregnancy.