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Diagnosis of pregnancy
Diagnosis of pregnancy Course of pregnancy is divided into three trimesters
1. “Doubt” signs
a) Change of appetite
b) CNS changes - Depression Sleeplessness or insomnia Irritability
c) Nausea and vomiting
2. “Maybe” signs
a) Retardation of menstruation – amenorrhea
b) Breast changes – Breast fullness and tenderness. Hyperpigmentation of the nipple and the surrounding areas by the 8th week
c) Bladder symptoms – Increased frequency of nicturia
We can find other “maybe” signs during special gynaecological examination. By putting a speculum we can define other changes of vagina and uterus, becomes blue – violet in colour
In vaginal examination we can study the vagina and uterus
· Increasing size of uterus. That is it becomes shaped and soft in consistency
· Palmars sign ( in time of vaginal examination ): uterus can constrist and relax ( alteration of consistency of uterus )
· Gigers’ sign: internal and external fingers can be approximated if uterine isthmus is soft and empty
· Genter sign: The areas of implantation of ovum in the uterus becomes larger than the other side of the uterus
· Piscachets’ sign: Alteration of consistency and size of uterus in the early gestation period.
3. Cardial signs / “Sure” signs
a) Palpation of foetal parts ( at the 26th week )
b) Auscultation of heart rate; when pregnancy is at the 7th week, by ultra sonography and after 20th week by stethoscope through the abdominal wall
Note: The size of the uterus is not a sure sign, as the uterus can increase in size in cancer and some other pathology
4. Laboratory signs
a) Pregnancy test
b) Hormonal test – level of gonadotropin increases during pregnancy
c) Immunological test – If one drop of morning urine contains chorionic gonadotropin is mixed with 1 drop of chorionic gonadotropin serum
No agglutination – Positive reaction; Pregnant
Agglutination – Negative reaction; Not pregnant
5. Biological test ( Presently not used )
Introduce urine of woman intramuscularly into mouse and after 72 hours if there is haemorrhage of the ovaries the woman is pregnant
Vomiting In the early pregnancy the most frequent complication is vomiting.
There are 3 degrees of severity.
a) Slight degree – when vomiting occurs 3 – 5 times
b) Mild degree – when vomiting occurs up to 10 times
c) Severe degree – when vomiting occurs up to 30 times
About 50% of pregnant women suffer from nausea, morning sickness or vomiting This condition usually begins between the 4th and 12th week and disappears after the 12th week
The slight vomiting is not treated as it is a usual condition. We treat only severe vomiting during pregnancy
Hyperemesis gravidarum
It means excessive vomiting affecting the general health of the pregnant woman, weight loss, dehydration and system affection Hyperemesis gravidarum occurs in 1 of 300 pregnant women
Etiology:
There are several theories but none are proven.
· Hormonal theory: the high level of human gonadotropins activates centers in the brain. This is the most accepted theory and proved by frequency of vomiting incase of trophoblastic diseases and cases of multiple pregnancy
· Allergic theory: The allergen maybe the patients’ corpus luteum. This is provided by some improvement of some patients using antihistamines
· Deficiency theory: Adrenocortical insufficiency. Improvement of some patients after cortical therapy
· Neurological theory: incase of rejection of pregnancy, fear of joblessness ( social cause of vomiting ), no husband, etc.
Clinical picture
Tachycardia
Hypotension due to hypovolemia
Slight rise of temperature
Pathological and biochemical changes
· Liver: Small Glycogen depletion
· Kidney: Tubular degeneration
· Heart: Slightly atrophic
· Nerves: Peripheral neuritis
· Brain: Congestion Haemorrhage
· Blood: Hypovolemia Hypoconcentration Hyponatremia Hypokalemia Acetonemia Hyperbilirubinemia Acidosis
· Urine: Oliguria Increased specific gravity Proteinuria Bile cells
Treatment of hyperemesis
Nutrition
No oral feeds until vomiting stops
Intravenous fluid volume 2 – 3 liters of physiological solution, glucose solution and any polyionic solution ( not colloidal because the patient is suffering from dehydration ) together with vitamins, sedative drugs and drugs for stopping of vomiting ( Domperidol, antihistamines, corticosteroids incase of hypertension )
Observation:
Colour
Contents
3. Vital signs : Blood pressure
Heart rate
Temperature
4. Skin conditions
5. Tongue conditions
6. Urine analysis: Acetone
Protein
Increased specific gravity
Bile pigments
7. Blood analysis: Haemoglobin
Haematocrit ( sign for degree of hypovolemia; increased haematocrit shows increased hypovolemia)
Termination of pregnancy
Indications:
Termination is by abortion if less than 12 weeks
External examination ( Sequence )
1. Age
2. Estimation of height, gait and constitution
3. Anamnesis:
6. External obstetric examination:
Palpation of foetus
1st manual: To estimate the standing of foetus
To estimate the part of foetus on superior part
2nd manual: To estimate the position of foetus
3rd manual: To estimate the presented part of foetus
4th manual: Only during labour;
to estimate the position of presented part along the planes of diameters
5th manual: Auscultation of heart beat
- Till 14 weeks
- From 14 – 28 weeks
- From 28 – onset of labour
1. “Doubt” signs
a) Change of appetite
b) CNS changes - Depression Sleeplessness or insomnia Irritability
c) Nausea and vomiting
2. “Maybe” signs
a) Retardation of menstruation – amenorrhea
b) Breast changes – Breast fullness and tenderness. Hyperpigmentation of the nipple and the surrounding areas by the 8th week
c) Bladder symptoms – Increased frequency of nicturia
We can find other “maybe” signs during special gynaecological examination. By putting a speculum we can define other changes of vagina and uterus, becomes blue – violet in colour
In vaginal examination we can study the vagina and uterus
· Increasing size of uterus. That is it becomes shaped and soft in consistency
· Palmars sign ( in time of vaginal examination ): uterus can constrist and relax ( alteration of consistency of uterus )
· Gigers’ sign: internal and external fingers can be approximated if uterine isthmus is soft and empty
· Genter sign: The areas of implantation of ovum in the uterus becomes larger than the other side of the uterus
· Piscachets’ sign: Alteration of consistency and size of uterus in the early gestation period.
- At 7th week the size of uterus us as large as a “hens egg”
- At 10th week it’s the size of an orange
- At 12th week it’s the size of a grape fruit or a mans fist
- After the 12th week the uterus can be defined by hand. The upper pubis and the fundus height increases progressively until near term
- At 20th week the fundus of the uterus lie 2 fingers below the normal
- At 24th week the fundus of uterus lies on the level of the navel
- At 32nd week the fundus lies between navel and sternum
- At the 36th week the fundus lies below the sternum
- At the 38th week the fundus of uterus is at the most high point
- At the 40th week the fundus lie two fingers below the sternum. The foetus presses towards pubis as the fundus of uterus
3. Cardial signs / “Sure” signs
a) Palpation of foetal parts ( at the 26th week )
b) Auscultation of heart rate; when pregnancy is at the 7th week, by ultra sonography and after 20th week by stethoscope through the abdominal wall
Note: The size of the uterus is not a sure sign, as the uterus can increase in size in cancer and some other pathology
4. Laboratory signs
a) Pregnancy test
b) Hormonal test – level of gonadotropin increases during pregnancy
c) Immunological test – If one drop of morning urine contains chorionic gonadotropin is mixed with 1 drop of chorionic gonadotropin serum
No agglutination – Positive reaction; Pregnant
Agglutination – Negative reaction; Not pregnant
5. Biological test ( Presently not used )
Introduce urine of woman intramuscularly into mouse and after 72 hours if there is haemorrhage of the ovaries the woman is pregnant
Vomiting In the early pregnancy the most frequent complication is vomiting.
There are 3 degrees of severity.
a) Slight degree – when vomiting occurs 3 – 5 times
b) Mild degree – when vomiting occurs up to 10 times
c) Severe degree – when vomiting occurs up to 30 times
About 50% of pregnant women suffer from nausea, morning sickness or vomiting This condition usually begins between the 4th and 12th week and disappears after the 12th week
The slight vomiting is not treated as it is a usual condition. We treat only severe vomiting during pregnancy
Hyperemesis gravidarum
It means excessive vomiting affecting the general health of the pregnant woman, weight loss, dehydration and system affection Hyperemesis gravidarum occurs in 1 of 300 pregnant women
Etiology:
There are several theories but none are proven.
· Hormonal theory: the high level of human gonadotropins activates centers in the brain. This is the most accepted theory and proved by frequency of vomiting incase of trophoblastic diseases and cases of multiple pregnancy
· Allergic theory: The allergen maybe the patients’ corpus luteum. This is provided by some improvement of some patients using antihistamines
· Deficiency theory: Adrenocortical insufficiency. Improvement of some patients after cortical therapy
· Neurological theory: incase of rejection of pregnancy, fear of joblessness ( social cause of vomiting ), no husband, etc.
Clinical picture
- Excessive vomiting; she cannot retain water or fluid and cannot eat or drink. Examination shows signs of dehydration
- Weight loss; non – elastic skin
Tachycardia
Hypotension due to hypovolemia
Slight rise of temperature
- Oligouria
- Jaundice
- Manifestation of peripheral neuritis and encephalopathy
Pathological and biochemical changes
· Liver: Small Glycogen depletion
· Kidney: Tubular degeneration
· Heart: Slightly atrophic
· Nerves: Peripheral neuritis
· Brain: Congestion Haemorrhage
· Blood: Hypovolemia Hypoconcentration Hyponatremia Hypokalemia Acetonemia Hyperbilirubinemia Acidosis
· Urine: Oliguria Increased specific gravity Proteinuria Bile cells
Treatment of hyperemesis
- Admit to hospital
- Analysis of blood for haemoglobin, haematocrit, electrolysis
- Restrict oral intake initially
- Intravenous fluid therapy
- Termination of pregnancy in severe cases
Nutrition
No oral feeds until vomiting stops
Intravenous fluid volume 2 – 3 liters of physiological solution, glucose solution and any polyionic solution ( not colloidal because the patient is suffering from dehydration ) together with vitamins, sedative drugs and drugs for stopping of vomiting ( Domperidol, antihistamines, corticosteroids incase of hypertension )
Observation:
- Antidehydration therapy
- Vomiting: Frequency
Colour
Contents
3. Vital signs : Blood pressure
Heart rate
Temperature
4. Skin conditions
5. Tongue conditions
6. Urine analysis: Acetone
Protein
Increased specific gravity
Bile pigments
7. Blood analysis: Haemoglobin
Haematocrit ( sign for degree of hypovolemia; increased haematocrit shows increased hypovolemia)
Termination of pregnancy
Indications:
- Ineffective therapy
- Persistant vomiting
- Tachycardia > 100 beats / min
- Hypotension < 100 systolic tension
- Temperature > 38*
- Appearance of jaundice
- Progressive oligouria and proteinuria
- Retinopathy
- Encephalopathy
Termination is by abortion if less than 12 weeks
External examination ( Sequence )
1. Age
2. Estimation of height, gait and constitution
3. Anamnesis:
- Previous diseases
- Character of menstrual cycle
- Health of husband
- Time of last menstruation
- Gynaecological diseases
- Reproductive system
- course of pregnancy
- Complications
- Conditions of foetus
- Lactation
- Number of pregnancies
- complication in 1st, 2nd and 3rd trimesters
- Increase of weight
- Blood pressure
- Analysis of urine
6. External obstetric examination:
- Circumference of abdomen
- Standing of fundus of uterus
- Diameters
- Distances; Spinarum, Cristarum, trochantis, external diagonal; between pubis and apex of rhombus
Palpation of foetus
1st manual: To estimate the standing of foetus
To estimate the part of foetus on superior part
2nd manual: To estimate the position of foetus
3rd manual: To estimate the presented part of foetus
4th manual: Only during labour;
to estimate the position of presented part along the planes of diameters
5th manual: Auscultation of heart beat
dr.rufusrajadurai |
Latest page update: made by dr.rufusrajadurai
, Jan 21 2008, 6:38 PM EST
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cardial signs of pregnancy
diagnosis
diagnosis of pregnancy
doubt signs of pregnancy
laboratory signs of pregnancy
pregnancy
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