Diagnosis of pregnancy.pptx

Editor's Notes

1. Mrs. Rani, 24 years old, comes to the OPD and says that she has not got her periods for the past 2 months. She also has vomiting sensation especially in the mornings. You notice some pigmentation on her cheeks. What is the first thing that comes to your mind? (record the responses on a flip chart and discuss). The woman may be pregnant. How do we guess that? From the symptoms the woman complains of and the signs she shows. History taking and physical examination along with symptoms and signs of pregnancy gives us a fair idea about whether the woman is pregnant or not. To confirm the diagnosis we can do certain tests. Today we will discuss and learn about the symptoms and signs of pregnancy and how to diagnose it. The objectives of the session are: to Describe the symptoms and signs of pregnancy, explain the methods of diagnosing pregnancy and to demonstrate the steps for testing pregnancy using the pregnancy testing kit – Nishchay
2. Pregnancy is the fertilization of the ovum by the sperm to form the zygote; it’s implantation in the uterus and its development as an embryo and later the fetus.The duration of pregnancy can be divided into 3 trimesters- first, second and third trimester each lasting for a period of three months.  
3. How will you know that a woman is pregnant? During pregnancy, the body of the woman undergoes various changes which cause certain symptoms the woman complains of and certain signs that can be elicited. What do you mean by symptoms? Symptoms are some changes in the woman’s body which she can feel and tell. Can you tell some of the changes that the woman can feel in her body during pregnancy?
4. noticed after 4 weeks of the previous menstrual period when the menstrual flow does not occur in the current month at the due date. Some women may have spotting during the time of missed period
5. usually occurs from 4-14 weeks. The woman may have nausea and sometimes vomiting in the morning which gradually gets better during the day. It usually subsides in the second trimester.
6. 6-12 weeks. The woman may have the urge to pass urine very frequently. This is due to the compression of the bladder by the growing uterus. It subsides when the uterus grows and after 12 weeks becomes an abdominal organ.
7. 16-20 weeks onwards. It may occur earlier in multigravida and a little late in primi woman. It is the first feeling of the fetal movements by the woman.
8. occurs from 3-4 weeks. There is growth and enlargement, tenderness and hypersensitivity , darkening of nipples and areolas (the skin around the nipples), darkened veins along the breasts (due to increased blood supply to your breasts), Nipples stick out more as the areolas and nipples will grow larger, small glands on the surface of the areolas called Montgomery’s tubercles become raised bumps. All these occur one after the other in a progressive manner
9. 12 weeks onwards. After 12 weeks, the uterus becomes an abdominal organ and begins to grow. The enlargement of the abdomen is a good sign of fetal growth
10. 8 weeks onwards. On inspection of the vulva and vagina using a vaginal speculum, dark purplish red discoloration and congestion of the vulva and vaginal mucosa is seen. This is not frequently elicited in all health settings.
11. 16 weeks onwards. The woman may feel wave like contractions in her abdomen which appear and then disappear spontaneously. She may feel it as a cramp in the abdomen.
12. With availability of simple and reliable tests for pregnancy as by the kit Nishchay, these signs of pregnancy are not elicited as a routine in all hospitals: 6-12 weeks. On bimanual examination ( under aseptic precautions, two fingers of the right hand are inserted per vaginum and the isthmus of the cervix is felt. The finger tips of the left hand is placed in the lower abdomen, just above the symphysis pubis. Both the hands are opposed to each other and the soft isthmus is felt with the fingers) , a firm cervix is felt in contrast with the softer body of the uterus and compressible, soft isthmus.
13. 8 weeks onwards. Pigmentations are seen on the face and abdomen.
14. Linea nigra, pigmented line extending from the symphysis pubis to the umbilicus and later to the xiphi sternum can be seen
15. Striae gravidarum, silvery white stripes are seen in the abdomen extending to the thighs . These striae are due to stretching of the abdominal skin and can be seen in later half of pregnancy
16. Fetal parts can be palpated from 24 weeks onwards.
17. 22 weeks onwards, but may be palpable earlier in multigravida. In late pregnancy especially in thin built women, fetal parts can be visible.
18. 11-12 weeks onwards by doppler. 20 weeks onwards by stethoscope/fetoscope.
19. 12-16 weeks onwards. It is the soft blowing sound, synchronous with the maternal pulse, produced by the passage of blood through the dilated uterine vessels. Can be elicited with a stethoscope, most distinctly in the lower portion of the uterus.
20. We have now seen the symptoms of pregnancy. Apart from this, the woman also presents with certain signs that can be elicited on examination. Can you mention a few of them? 9-10 days. It is produced by the placenta and is released in the blood stream of the woman. from 14 days onwards. The HCG from the pregnant woman’s blood is excreted in the urine and can be detected by simple tests.
21. from 4-5 weeks. In general terms it is called scan. In private settings, ultrasound is done to confirm pregnancy and subsequently to monitor the growth of the fetus.
22. History taking and physical examination will be dealt with in detail in the next sessions. In this session we will discuss the symptoms and signs of pregnancy and detection and confirmation of pregnancy by a simple immunological pregnancy test using the kit Nishchay