Diagnosis of
Pregnancy
Liu Wei
Department of Ob & Gy
Ren Ji hospital
Diagnosis of Early Pregnancy
? History and symptoms
1,Amenorrhea
1) The first and the most important symptom
2) Note 1,emotional tension,chronic disease
and certain medications → delayed menses
3) Note 2,lactation,IUD and dysfunction of
endocrine → pregnancy
Diagnosis of Early Pregnancy
2,Morning sickness
1) Fatigue,swirling,nausea and vomiting (the
6th week↑ → the 12th week↓ ),
2) Hyperemesis gravidarum (妊娠剧吐 ),
protracted vomiting necessitating
hospitalization,
3) Causes,HCG,delayed gastric emptying(P↑ )
Diagnosis of Early Pregnancy
3,Urinary symptoms
1) Bladder irritability,frequency and nocturia
2) Causes,increased circulation in pelvis (E and
P↑ ),enlargement of the uterus,
3) Note,urinary infection must be ruled out
Diagnosis of Early Pregnancy
4,Mastodynia (乳房胀痛 )
1) the development of mammary ducts (E↑ )
and alveolar system (P↑ )
2) circulation↑→ engorgement of the breasts
5,Constipation (便秘 )
smooth muscle relaxant (P↑ )
6,Weight gain
Diagnosis of Early Pregnancy
? Signs
1,The changes of genital organs
1) Vagina,bluish or purple discoloration
(congested pelvic vasculature),Increased
vaginal discharge (E and P↑ )
2) Cevix,softening and bluish discoloration,The
cervical mucus→ a granular pattern
3) Uterocervical junction
Hegar’s sign,a widened zone of softness coupled
with compressibility,resulting in a doughnut-
shaped,slightly spongy configuration,
Hegar’s sign
Diagnosis of Early Pregnancy
4) Abdominal enlargement
Enlargement of uterus (noticed at the 12th
week)
2,Breast changes
1) Enlargement and vascular engorgement (6th –
8th week)
2) Montgomery’s tubercles (蒙氏结节 ),6th –8th
week,E and P↑
3) Colostrum secretion (16th week) or secondary
breasts
Diagnosis of Early Pregnancy
? Laboratory tests
1,Pregnancy test
1) Urine HCG test (one step),+ or –
2) β -HCG,>25mIU/L
2,Ultrasonography
1) Enlargement of uterus
2) Gestational sac
3) Embryo or fetal pulse
Diagnosis of Early Pregnancy
3,Other tests
1) Progesterone test
2) Cervical mucus examination
3) Basal body temperature (BBT)
Diagnosis of mid or late pregnancy
? Symptoms and signs
1,EDC,+9 or –3 (month),+7 (day)
2,Enlargement of uterus
1) 12th week,2 finger above the symphysis
2) 16th week,midway between the symphysis
and the umbilicus,
3) 20th – 22nd week,at the umbilicus
4) ……,
Diagnosis of mid or late pregnancy
3,Fetal movement (FM)
1) The first perception,in the 18th – 20th weeks
2) Diagnosis of pregnancy,duration of
pregnancy,the safety of fetus
3) Count,3 times per day,1 hour per time,
sum× 4= FM/12 hours,Normal:≥ 30/12
hours
Diagnosis of mid or late pregnancy
4,Fetal heart tones
1) Heared,the 18th – 20th weeks
2) Normal rate,120-160bpm
3) Differentiation,umbilical souffle (脐带杂音 )
5,Fetal body
Palpated,outlines of the fetus (the 20th week),
Diagnosis of mid or late pregnancy
? Laboratory tests
1,Ultrasonography
1) The number of fetus
2) Fetal lie
3) Fetal presentation
4) Fetal position
5) Fetal dead or not
6) Placenta and cord (velocity of flow)
7) Size of fetus
Diagnosis of mid or late pregnancy
2,Fetal electrocardiography,FECG
12th week
Fetal Attitude
? Fetal lie
Refers to the relationship of the long axis of
the fetus to the long axis of the mother
1,Longitudinal lie
The long axis of the fetus is parallel with that
of the mother
2,Transverse lie
The long axis of the fetus crosses that of the
mother vertically
Fetal lie
Fetal Attitude
? Fetal presentation
1,head presentation
Occiput presentation (95%),brow
presentation and face presentation,
2,Breech presentation
1) Complete breech presentation
2) Frank breech presentation
3) Incomplete breech presentation,footling
presentation
Head presentation or breech
Fetal Attitude
? Fetal position
Refers to the relationship of the point of
direction of the presenting part to one of the 4
quadrants of the pelvis or to the transverse
diameter of the maternal pelvis,
1,Occiput presentation,the occiput,O,
LOA,LOT,LOP
2,Face presentation,the chin,M,
LMA,LMT,LMP
3,Breech presentation,the sacrum,
S.LSA,LST,LSP
Fetal position
END