Diagnosis of Pregnancy
1. First trimester (0-3 months)
First 12 weeks
1. Subjective symptoms
2. Objective symptoms
1. Subjective symptoms
a. Amenorrhea
b. Morning sickness/nausea and vomiting
Due to rise in hCG (Human chorionic gonadotropin)
c. Frequency of micturition (8-12th week)
d. Breast discomfort (6-8 weeks)
Breast pain, feeling of fullness, pricking sensation, breast vein prominent, primary areola, pigmentation around primary areola called secondary areola.
e. Fatigue and lethargy
2. Pelvic changes
1. Jacquemier’s or Chadwick’s sign (8th week)
Bluish discoloration of anterior vaginal wall.
2. Vaginal sign
Bluish discoloration of skin.
3. Osiander’s sign
Feeling of pulsation in vagina.
4. Cervical sign
1. Goodell’s sign (6th week)
Softening of cervix like lip of mouth.
In non-pregnant woman-like tip of nose.
2. Uteine sign
a. Piskacek’s sign
Shape of uterus change.
Enlarged size
Pyriform in non-pregnant woman.
Globular in pregnant women by 12 weeks.
b. Hegar’s sign (6-10 weeks)
Upper segment of body of uterus enlarged by growing fetus, and low segment empty.
c. Palmer’s sign (4-8 week)
Regular and rhythmic uterus contraction (Bimanual examination).
d. Enlarge, shape, size of uterus
3. Breast changes
1. Enlargement of breast (6-8 weeks)
2. Growth of breast
3. Enlargement with vascular engorgement
4. Vein prominent and increase vascularity
5. Primary areola more pigmented. Nipple and areola (primary) become pigmented.
Appearance of secondary areola.
6. Montgomery’s tubercles are prominent (hypertrophy of sebaceous gland).
7. Colostrum
Watery type secretion when mother manually expressed (12-16 weeks).
Detection of antigen (hCG) present in maternal urine or serum with antibody.
Diagnosis of pregnancy by detecting in hCG in maternal serum or urine made by 7 days after conception.
Ultrasonography; Intra decidual gestational sac (GS) identified early 29-35 days of gestation.
Fetal pole and cardiac activity; 6 week
2. Second Trimester (13-28 weeks)
3-6 months.
1. Subjective symptoms
2. Objective symptoms
1. Subjective symptoms
a. Abdominal examination
1. Inspection
Linea nigra; dark pigmented line made from symphysis pubis to xiphisternum visible at 20th week.
Striae; (both pink and white)
Visible in lower abdomen (side stretch mark).
2. Palpation
a. Fundal height
Increased, enlargement of uterus.
Height of uterus is midway between symphysis pubis and umbilicus at 16 weeks.
Level at umbilicus at 24th week.
b. External ballottement
Through abdomen put hand on abdomen (20th week).
Feeling for movable object.
3. Auscultation
Doppler ultrasound device; 12 weeks
Fetoscopy; 18-20 weeks
Uterine Souffle;
Two other sound can confuse with fetal heart rate.
1. Maternal souffle; mother blood to placenta.
2. Fetal souffle; fetus blood to mother.
Rush of blood through umbilical artery.
General Examination
1. Chloasma
Pigmentation of forehead, nose, cheek (24 weeks).
2. Change in Breast
1. Enlargement of breast
2. Prominent veins under skin
3. Secondary areola appears 20th weeks
4. Montgomery’s tubercles prominent, extend to secondary areola.
5. Colostrum become think and yellowish (16th weeks).
Vaginal Examination
1. Bluish discoloration of valva, vagina, cervix (softening of cervix).
2. Internal ballottement (16-28th week)
Through vagina; insert the right hand finger.
2. Subjective symptoms
1. Quickening; feeling of life inside womb.
2. Progressive enlargement
Investigation
1. Sonography (18-20 weeks)
Placental localization
Fetal anatomy; detect malformation, fetal cardiac motion
Integrity of cervical canal
3. Third trimester (29-40 weeks)
6-9 months
1. Subjective symptoms
2. Objective symptoms
1. Subjective symptoms
a. Lightening
Descending of fetus into pelvis.
(Engagement of presentating part).
b. Frequency of micturition
c. Fetal movement felt
4. Braxton-Hicks contraction evident
5. Palpation of fetal part
2. Objective Symptoms
1. Cutaneous change
Striae more pigmented.
2. Uterine shape spherical (36th week)
3. Fundal height increases
If head is floating (32 weeks pregnancy)
If head engaged (37 week pregnancy)
4. Four grips in pregnancy
4 steps of leopold’s maneuver;
1. Fundal grip
(Maneuver one)
2. Lateral grip
(Maneuver two)
3. Pawlick’s grip
(Maneuver three)
4. Pelvic grip
(Maneuver four)
