Diagnosis of Pregnancy

18-Apr-24
 objectives
2

At the end of session students should able to:

Discuss symptoms, signs and laboratory diagnosis of
pregnancy
Outline Probable, Possible and Positive evidences of
pregnancy

18-Apr-24
 Introduction
3

Pregnancy (gestation) is the maternal condition of

having a developing fetus in maternal body.
The average duration of pregnancy is :
Nine calendar months + 10 days or 40 weeks /280 days
• Less than 28 weeks of gestation = commonly Abortion
• 28-37 weeks of gestation = preterm
pregnancy/labour
• 37 completed weeks or 38-42 weeks of gestation =
term pregnancy/ labour
• Greater than 42 weeks = post term
pregnancy/labour 18-Apr-24
 Diagnosis- cont’d
4

Evidences for the diagnosis of pregnancy could be

Presumptive evidences possible symptoms -not
specific
Probable evidences- give clues for pregnancy
Positive evidences/ absolute

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 Diagnosis- cont’d
5

The possible symptoms: changes in her body that a

woman can identify for herself and tell you about it
which may mean she is pregnant, but they could also be
caused by something else.
The probable signs and symptoms: some of these
indicators are reported by the woman, but you can also
see them for yourself.
The positive signs: these are absolute proof of
pregnancy, based on objective findings
18-Apr-24
 A. Presumptive (possible) symptoms
6

Amenorrhea. Amenorrhea, or the abrupt cessation of

spontaneous menstruation, is strongly suggestive of
pregnancy.
Could be due to stress, chronic illness
Breast changes. In very early pregnancy (3-4 wks),
women report tenderness and tingling in the breasts.
Breast enlargement and nodularity are evident as
early as the second month of pregnancy.
The nipples and areolae enlarge and become more
deeply pigmented. 18-Apr-24
 Presumptive (possible) symptoms…..cont
7

Breast changes
Breast enlargement and
vascular engorgement.
Nipple and areola
become blacker.
Enlargement of the
accumulated sebaceous
glands of the areolas
(Montgomery’s tubercles)
may be noted
DDx contraceptive pill
18-Apr-24
 Presumptive (possible) symptoms….cont
8

Nausea (with or without vomiting). Also

called morning sickness because they occur upon
arising.
These symptoms appear one or two weeks after the
period is missed and last until 10th to 14th week, its
severity varies from mild nausea to persistent vomiting
(e.g. Hyperemesis gravidarum).
DDx Gastrointestinal disturbances PUD
Intestinal parasitosis, gastritis,,
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 Presumptive (possible) symptoms…..cont
9

Disturbances in urination. Frequent Urination

Early in pregnancy ( 6-12 wks ), the enlarging uterus
puts pressure on the bladder, causing frequent urination.
common in 1st and 3rd trimesters
This condition improves as the uterus grows and moves
up into the abdomen but returns late in pregnancy when
the fetal head settles into the pelvis against the bladder
DDx urinary tract infection

18-Apr-24
 Presumptive (possible) symptoms…..cont
10

quickening : Sensation of fetal movement. Between

the 16th and 20th week after the last menstrual period
woman begins to feel movement in the lower abdomen,
described as a fluttering or gas bubbles. This is known
as quickening. Confusion with peristalsis
Prim 18-20 weeks
Multi: 14-16 weeks
Fatigue. Tiredness is one of the earliest symptoms of
pregnancy. Fatigue usually persists into the second
trimester 18-Apr-24
 Presumptive (possible) symptoms…..cont
11

• Skin changes Pigmentation: 8 weeks on wards

Chloasma, stria, linea nigra
due to increased melanocyte stimulating
hormone:
- linea nigra: pigmentation of the linea alba, more
marked below the umbilicus
- chloasma gravidarum: Butterfly pigmentation of the
face (mask of pregnancy)
- Striae gravidarum
- stretch of the abdominal wall
rupture of the subcutaneous elastic fibers
pink lines in flanks
become white after labor 18-Apr-24
 Presumptive (possible) symptoms…..cont
12

Chloasma
(mask of pregnancy) a butterfly pigmentation on the
cheeks and nose . It usually disappears few
months after labour

18-Apr-24
 Presumptive (possible) symptoms…..cont
13

Linea Nigra

pigmentation in midline below the18-Apr-24

umbilicus
 Presumptive (possible) symptoms…..cont
14

pigmentation in the lower

abdomen, flanks , inner thighs,
buttocks & breast and
increase as pregnancy
advances
It starts pink (stria rubra) then
becomes pale to become
white (stria albicans) after
delivery, which persists
Stria gravidarum
18-Apr-24
 B. Probable evidences
15

Pelvic changes :
- Chadwick’s sign: bluish discoloration of vagina &
cervix 8 wks on wards
- Hegar’s sign: softening of the Isthmus 6- 12 wks
- Goodell's sign (a softening of the cervix at around six
to eight weeks of gestation)
- Osinder’s sign: pulsation of fornices 8 wks on wards
DDx- pelvic congestion, Tumours
Abdominal enlargement: uterus just palpable at
symphysis at 12 weeks
Braxton- Hicks contraction: irregular contraction 16
weeks
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 Probable…… cont’d
16

Ballotment of the uterus: both internal & external on16-28

wks
Uterine soufle: soft sound heard while auscultating FHB
and parallel with maternal pulse 12-16 wks
DDx- myomas, ovarian tumours
Pregnacy tests: Depends on detection of HCG in serum or
urine HCG produced by trophoblast
Most sensitive assays detect HCG in serum as early as 6
days & in urine 26 days after conception .
HCG secretion is a mximum at around 65 days after
conception 18-Apr-24
 Positive Evidences
17

No alternative diagnosis
Fetal heart tones
fetoscope: 18-20 weeks
Doppler: 10-12 weeks
Fetal movements palpated 22weeks
Seeing fetal movement on inspection in late pregnancy
Fetal parts palpated at 24weeks
Ultrasound at 6 weeks on wards
Radiological at 16 weeks on wards

18-Apr-24
 Positive Evidences …cont
18

18-Apr-24
 Diagnosis of pregnancy
19

The diagnosis of pregnancy requires a multifaceted

approach using 3 main diagnostic tools:
• History and physical examination,
• Laboratory evaluation, and
• Ultrasonography.
Currently, we may use all of these tools to
diagnose pregnancy at early gestation and to
help rule out other pathologies.

18-Apr-24
 Cont…
• Gravidity is the total number of previous pregnancies,
regardless of the pregnancy duration the outcome,
including spontaneous miscarriage or abortion before
28 wks of gestation.

• Nulligravida: woman who is not currently pregnant

and has never been pregnant
• primigravida: first pregnancy
• Multigravida: woman who is pregnant currently for
more than the first time (number not specified)
18-Apr-24 20
 Cont…
• Parity is the number of babies delivered either alive or
dead after 28 wks of gestation
• Nullipara or Para 0: woman who has never give birth
or no pregnancy reached 28ks
• Primipara or Para 1: one birth after 28 weeks
• Multipara: two or more births after 28wks (number not
specified)
• Grand multipara: five or more births after 28 wks.
18-Apr-24 21
 Test 1
A women came to you with complain of nausea and vomiting of a
week. On history, she has two alive baby and one neonatal loss.
She has one history of abortion and one stillbirth. She didn’t
remember her LNMP, but claim that she was amenorrhic for the last
three months. On physical examination there are positive fetal
heart beat, breast tenderness, darkening of linea alba and bluish
discoloration of cervix. Lab test evidenced that urine is positive for
HCG. Based on the above case attempt the following questions.
1. What is her gravidity?
2. What is her parity?
3. What presumptive manifestations does the woman has?
4. What positive sign does the woman has?
5. What probable sign does the woman has?

18-Apr-24 22