PREGNANCY (‫)ﺣﻤﻞ‬

BY
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Prof. RUBI ANJUM (Chairperson)

D/o Tahaffuzi Wa Samaji Tib
Faculty of Unani Medicine, AMU
ALIGARH.
Pregnancy is a physiological state in female
where she conceives and carries
developing product of conception in her
womb until birth of a child.

‫ﺣﻤﻞ ﻋﻮﺭﺗﻮﮞ ﮐﯽ ﺍﯾﺴﯽ ﺣﺎﻟﺖ ﮨﮯﺟﺲ ﻣﯿﮟ ﺑﺎﺭﺁﻭﺭﺑﯿﻀﮧ ﺭﺣﻢ‬

‫ﻣﺎﺩﺭ ﻣﯿﮟ ﭘﯿﺪﺍﺀﺵ ﮐﮯ ﻭﻗﺖ ﺗﮏ ﻧﺸﻮ ﻭ ﻧﻤﺎ ﭘﺎ ﺗﺎ ﮨﮯ۔‬
DIAGNOSIS OF PREGNANCY IN
LIVING Diagnosis of pregnancy in living is done on
presence of signs and symptoms in the female.These
signs and symptoms are divided into three groups..

• Presumptive sign‫ﺍﺣﺘﻤﺎﻟﯽ‬
1. ‫ﻋﻼﻣﺎﺕ‬

• Probable sign (‫ﻣﻤﮑﻨﮧ )ﻏﯿﺮ ﯾﻘﯿﻨﯽ‬

2. ‫ﻋﻼﻣﺎﺕ‬

• Positive sign‫ﯾﻘﯿﻨﯽ ﻋﻼﻣﺎﺕ‬

3.
 PRESUMPTIVE SIGN(‫)ﺍﺣﺘﻤﺎﻟﯽ ﻋﻼﻣﺎﺕ‬
SYMPTOMS
1. Secondary Amenorrhea(‫)ﺍﺣﺘﺒﺎﺱ ﻃﻤﺚ‬: suggestive of
pregnancy but may occur in lactation, PCOD, Ovarian
dysgenesis, intense desire for pregnancy and fear of
pregnancy.
2. Morning sickness : usually in primigravida, but caused
by other conditions such as migraine and gastritis etc.
3. Sympathetic disturbances: salivation, perverted
appetite & irritability of temper.
4. Irritable temper
5. Fatigability
6. Frequency of micturition
 SIGNS
1. Changes in the breast: (‫)ﺗﻐﯿﺮﺍﺕ ﭘﺴﺘﺎﻥ‬
⚫ They becomes full, tender and increase in size.
⚫ Montgomery’s Tubercle present.
⚫ clear transparent secretion can be squeezed. ( colostrum)
2. Changes in vagina: (‫)ﺗﻐﯿﺮﺍﺕ ﻣﮩﺒﻞ‬
⚫ Due to increased vascularity pinkish mucosa of vagina changes
to bluish(Jacquemir’s sign/ Chadwick's sign).
⚫ Flattening of anterior vaginal wall (Barne’s sign).
⚫ Palpable pulsation of vaginal arteries (Osiander’s sign)
3. Pigmentation of skin: (‫)ﺗﻐﯿﺮﺍﺕ ﺟﻠﺪ‬
⚫ dark brown patches on forehead and cheeks.
⚫ A linear pigmentation present over abdomen(Linea Nigra).
⚫ Skin of abdomen shows depressed lines, pinkish or slightly
bluish in appearance (Straie Gravidarum)
LINEA NIGRA

STRAIE GRAVIDARUM
 PROBABLE SIGN (‫ﻣﻤﮑﻨﮧ ﯾﺎﻏﯿﺮ ﯾﻘﯿﻨﯽ‬
‫)ﻋﻼﻣﺎﺕ‬
SYMPTOM
1. QUICKENING (‫ )ﺍﺭﺗﮑﺎﺽ‬: is appreciation of fetal
movements by mother in her womb (18 th ‐20th weeks
of pregnancy)
 SIGNS
1. ENLARGEMENT OF ABDOMEN: (‫)ﺗﻐﯿﺮﺍﺕ ﺑﻄﻦ‬
Up to 12Weeks‐ In the uterine cavity.
By 12Weeks‐ just above Symphysis pubis.
At 16Weeks‐ Between umbilicus and symphysis pubis
At 24Weeks‐ at the level of umbilicus
At 28Weeks‐1/3 rd Between umbilicus and xiphisternum.
At 32Weeks‐ 2/3 rd Between umbilicus and xiphisternum.
At 36Weeks‐ at the xiphisternum.
2. CHANGES IN THE CERVIX: (‫ﺗﻐﯿﺮﺍﺕ ﻋﻨﻖ‬
‫)ﺍﻟﺮﺣﻢ‬
• Cervix becomes Soft as NOSE. (Goodell’s Sign
by 16th weeks)
• Presence of cervical mucus plug: Thick viscous
fluid block the opening of cervix.

3. UTERINE CHANGES: (‫)ﺗﻐﯿﺮﺍﺕ ﺭﺣﻢ‬

• lower uterine segment becomes Soft and easily
compressible. (Hegar's sign by 8 th to 10th weeks)

• Intermittent uterine contraction s occurring in the

uterus (Braxton‐Hick’s sign by 16 th weeks)
4. BALLOTTEMENTS (‫ )ﺗﮩﺰﯾﺮ‬:

These are objective signs of pregnancies and can be

elicited on internal and external examination.
External ballottement (‫)ﻇﺎﮨﺮﯼ ﺗﮩﺰﯾﺮ‬
In thus procedure the patient is asked to lie in
supine position. One hand is placed on one flank
and other hand displaces the foetus. The other
hand perceives the movement of fetus.
Internal ballottement (‫ )ﺍﻧﺪﺭﻭﻧﯽ ﺗﮩﺰﯾﺮ‬-here the test
is performed with patient is in lithotomy
position. Two fingers are inserted into vaginal
fornix. With the tips of fingers, the head is
gently pushed upwards. Here due to tossing ,the
fetus moves upward and returns back to its
ori8ginal position and the movement is felt by
the fingers.

INTERNAL BALLOTTEMENT
5. UTERINE SOUFFLE: (‫)ﺭﺣﻤﯽ ﺧﺮﯾﺮ‬
• It is a soft blowing murmur, caused due to passage of
maternal blood into the dilated arteries of uterus. The
murmur is synchronized with the pulse of mother. It
can be heard with a stethoscope applied on either side
of uterus. It is usually audible from 16th week onwards.
• The test to be not confused with fetal heart sound
because fetal heart sound are more rapid in its rate and
are not synchronized with mother’s pulse.
6. LABORATORY INVESTIGATION:
The laboratory test for pregnancy are classified as;
• Bio-assay or biological tests
• Immunoassay or immunological tests
• ELISA Test
• Radio-immunoassay.
BIOLOGICAL TEST OF
PREGNANCY

Ascheim‐ Friedma
zondek n

Galli‐
Hogben
mainini.
 IMMUNOLOGICAL TESTS-
Immunological tests are based on principle that-antigen
present in urine or serum reacts with antibody. There are
two types of test available :
1.Agglutination inhibition test
2.Direct agglutination test.
 POSITIVE SIGNS (‫)ﯾﻘﯿﻨﯽ ﻋﻼﻣﺎﺕ‬
1.FETAL PARTS AND FETAL MOVEMENT (‫ﺟﻨﯿﻦ ﺍﻭﺭ ﺍﺱ ﮐﮯ ﺍﻋﻀﺎﺀ ﮐﯽ‬
‫)ﺣﺮﮐﺎﺕ‬
The test can be done by palpation of fetal parts and
movements by placing hands over abdomen. Fetal
movements are appreciated by 16th -20 th weeks.
2. FETAL HEART SOUNDS (‫)ﻗﻠﺐ ﺟﻨﯿﻦ ﮐﯽ ﺁﻭﺍﺯ‬
• It is absolute sign of pregnancy and usually heard at about
18-20 week.
• Fetal heart sounds are like muffled tickling of a watch and can
be heard by fetoscope.
• The fetal heart sound rate is about 160/minute at 5 th month and
120/minute at 9 th month of pregnancy.
• FHS are not synchronous with mother’s pulse.
Fetal Heart Sound can be detected much earlier by using
advanced techniques:
• Doppler at about 10th ‐12 th weeks.
• Echocardiography can detect the FHS at about 7 th week
• Real time Sonography detects at about 8th week.
• FHS are not heard in:
‐when fetus is dead.
‐Hydramnios –excessive quantity of liquor amnii.
‐When abdominal wall is very thick.
‐Examination before 28th weeks.
‐Position of fetus.
3. X-RAY EXAMINATION
By x-ray ,the diagnosis of pregnancy can be certain after
16th week.
X-ray will reveal fetal skeleton in form of :
• ladder like shadow of ribs.
• beaded shadow of spine.
• linear shadows of limbs.
X rays are contraindicated in first trimester of
pregnancy due to radiation hazards.
X-ray sign of fetal death are:
• Presence of gas in heart and great vessels like aorta (Robert’s
sign)
• Collapse of spinal column due to loss of muscle tone-usually
hyper flexion of spine.
• overlapping of skull bones caused by liquefaction of brain
(Spalding’s sign)
4. SONOGRAPHY:

• At present, method of choice, easy and convenient.

• By this method gestational sac (ring) is determined
by 5th week, fetal pole by 6 th week, yolk sac at 6 th
week and Cardiac pulsation appreciated by at 7 th
week.
 MEDICOLEGAL IMPORTANCE
A) CIVIL CASES
⚫ Nullity of marriage: If a female is pregnant before marriage from
another person and she concealed the pregnancy at the time of
marriage with other man to whom she get married then the
marriage can be declared as null and void.
⚫ Divorce: Pregnancy resulted in a female who had no access (she had not
done sexual intercourse with her husband)to her husband within the
reasonable period matching with the duration of pregnancy then a decree of
divorce may be allowed to the husband
⚫ In case of breach of promise of marriage
⚫ In alimony: in divorce cases,pregnant women are allowed higher
maintenance allowance.
⚫ Inheritance of property
⚫ Blackmailing
⚫ Defamation
⚫ compensation case: if a husband of pregnant woman dies
due to negligence of another person, higher compensation is
paid.
B) CRIMINAL CASES
1.Pregnancy is a positive proof of sexual intercourse in rape cases.

2. Pregnancy may be cause for suicide in unmarried female

3. pregnancy may be motive for murder if that pregnancy is due to

:
• sexual intercourse by man with woman (illicit sexual
intercourse)
• murder may be done by husband when husband suspects that
his wife is pregnant by another person (infidelity of wife)

4. Execution of death sentence: UNDER SECTION 416 of CrPC,

there can be postponement of capital sentence of pregnant
woman-if woman sentenced to death is found to be pregnant ,
the high court shall order the execution of the sentence to be
imprisonment for life.

5-Pregnancy related with criminal abortion or concealment of

birth.
THANK

YOU….