Diagnosis of Pregnancy Liu Wei Department of Ob & Gy Ren Ji hospital.

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1 Diagnosis of Pregnancy Liu Wei Department of Ob & Gy Ren Ji hospital

2 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

3 Diagnosis of Early Pregnancy 2.Morning sickness 1)Fatigue, swirling, nausea and vomiting (the 6 th week ↑ → the 12 th week ↓ ). 2)Hyperemesis gravidarum ( 妊娠剧吐 ): protracted vomiting necessitating hospitalization. 3)Causes: HCG, delayed gastric emptying(P ↑ )

4 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

5 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

6 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.

7 Hegar’s sign

8 Diagnosis of Early Pregnancy 4)Abdominal enlargement Enlargement of uterus (noticed at the 12 th week) 2.Breast changes 1)Enlargement and vascular engorgement (6 th – 8 th week) 2)Montgomery’s tubercles ( 蒙氏结节 ): 6 th –8 th week, E and P ↑ 3)Colostrum secretion (16 th week) or secondary breasts

9 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

10 Diagnosis of Early Pregnancy 3.Other tests 1)Progesterone test 2)Cervical mucus examination 3)Basal body temperature (BBT)

11 Diagnosis of mid or late pregnancy Symptoms and signs 1.EDC: +9 or –3 (month), +7 (day) 2.Enlargement of uterus 1)12 th week: 2 finger above the symphysis 2)16 th week: midway between the symphysis and the umbilicus. 3)20 th – 22 nd week: at the umbilicus 4)…….

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13 Diagnosis of mid or late pregnancy 3.Fetal movement (FM) 1)The first perception: in the 18 th – 20 th 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

14 Diagnosis of mid or late pregnancy 4.Fetal heart tones 1)Heared: the 18 th – 20 th weeks 2)Normal rate: 120-160bpm 3)Differentiation: umbilical souffle ( 脐带杂音 ) 5.Fetal body Palpated: outlines of the fetus (the 20 th week).

15 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

16 Diagnosis of mid or late pregnancy 2.Fetal electrocardiography, FECG 12 th week

17 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

18 Fetal lie

19 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

20 Head presentation or breech

21 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

22 Fetal position

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