DIAGNOSIS OF DIAGNOSIS OF PREGNANCYPREGNANCY

HistoryHistoryPhysical examinationPhysical examination

InvestigationsInvestigationsDifferential diagnosisDifferential diagnosis

HISTORYHISTORYAMENORRHOEA – stress/emotional upset, lactation, contraceptive AMENORRHOEA – stress/emotional upset, lactation, contraceptive pill, hormonal (ovarian-pituitary) imbalancepill, hormonal (ovarian-pituitary) imbalanceBREAST CHANGES – Increase in size, heaviness/pain in the BREAST CHANGES – Increase in size, heaviness/pain in the breastsbreastsFREQUENCY OF MICTURITION – initially due to increased FREQUENCY OF MICTURITION – initially due to increased vascularity & pressure from the enlarging uterus but later due to vascularity & pressure from the enlarging uterus but later due to pressure from the fetal head on the bladder.pressure from the fetal head on the bladder.MORNING SICKNESS – gastric upset ranging from anorexia to MORNING SICKNESS – gastric upset ranging from anorexia to nausea and repeated vomiting especially in the morning (usually nausea and repeated vomiting especially in the morning (usually from the 6from the 6thth to 14 to 14thth Wk). Attributed to hCG levels due to higher Wk). Attributed to hCG levels due to higher incidence in multiple pregnancy/molar pregnancies. Severe form incidence in multiple pregnancy/molar pregnancies. Severe form →hyperemesis gravidarum→hyperemesis gravidarumPTYALISMPTYALISMABDOMINAL ENLARGEMENT – may initially be due to slight ABDOMINAL ENLARGEMENT – may initially be due to slight intestinal distension before the uterine enlargement becomes intestinal distension before the uterine enlargement becomes evident. Consider 5F’s.evident. Consider 5F’s.QUICKENING – Fetal movement may be slight initially and QUICKENING – Fetal movement may be slight initially and confused with wind in the intestine. It is first noticed at about the 16confused with wind in the intestine. It is first noticed at about the 16 thth Wk for multipara & 18Wk for multipara & 18thth – 20 – 20thth Wk for primigravida. In pseudocyesis, Wk for primigravida. In pseudocyesis, the patient convinces herself of its’ presence.the patient convinces herself of its’ presence.

PHYSICAL EXAMINATIONPHYSICAL EXAMINATION

SKIN CHANGES – pigmentation of the face & areola (1SKIN CHANGES – pigmentation of the face & areola (100 & 2 & 200) of the ) of the breasts; breasts; Montgomery’s tubercles (prominent sebaceous Montgomery’s tubercles (prominent sebaceous glands as pink red glands as pink red nodules on the areola)nodules on the areola)PROGRESSIVE ENLARGEMENT OF THE UTERUSPROGRESSIVE ENLARGEMENT OF THE UTERUSPAINLESS UTERINE CONTRACTIONS (can be felt even in a pelvic PAINLESS UTERINE CONTRACTIONS (can be felt even in a pelvic uterus with a co-operative patient)uterus with a co-operative patient)BALLOTTEMENT – internal (14 Wks) & external (24Wks)BALLOTTEMENT – internal (14 Wks) & external (24Wks)Palpation of FETAL PARTS(24-26Wks) & FETAL MOVEMENT Palpation of FETAL PARTS(24-26Wks) & FETAL MOVEMENT (20Wks)(20Wks)FETAL HEART SOUNDS (24FETAL HEART SOUNDS (24thth Wk), uterine soufflé (20 Wk), uterine soufflé (20thth Wk) & funic Wk) & funic soufflé (umbilical cord blood flow)soufflé (umbilical cord blood flow)JACQUEMIERS SIGN – darkening of vaginal skin (8Wks)JACQUEMIERS SIGN – darkening of vaginal skin (8Wks)HEGARS SIGN – softening of the lowest part of the body of the HEGARS SIGN – softening of the lowest part of the body of the uterus (8 Wks)uterus (8 Wks)OSIANDERS SIGN – increased pulsation in the lateral fornices OSIANDERS SIGN – increased pulsation in the lateral fornices (8Wks)(8Wks)SOFTENING & BLUE DISCOLORATION OF THE CERVIX SOFTENING & BLUE DISCOLORATION OF THE CERVIX (complete by the 16(complete by the 16thth Wk) Wk)

INVESTIGATIONSINVESTIGATIONS

Tests on maternal urine –Tests on maternal urine –

immunochemical tests immunochemical tests

Tests on maternal plasma/serum –Tests on maternal plasma/serum –

radioimmunoassays & enzyme-linked radioimmunoassays & enzyme-linked immunosorbent assays (ELISA) immunosorbent assays (ELISA)

Ultrasonography – Abdominal & trans-Ultrasonography – Abdominal & trans-vaginal, sonicaid (10Wks)vaginal, sonicaid (10Wks)

Abdominal X-raysAbdominal X-rays

DIFFERENTIAL DIAGNOSISDIFFERENTIAL DIAGNOSIS

Uterine fibroidsUterine fibroids

Ovarian cystsOvarian cysts

Distended bladderDistended bladder

Pregnancy associated with uterine Pregnancy associated with uterine fibroids/ovarian cystsfibroids/ovarian cysts

Pseudocyesis Pseudocyesis