BY DUMDUMA,R.N.,R.M.

Pregnancy:

FIRST TRIMESTER: (First 12 weeks) Presumtive symptoms: - Amenorrhoea - Morning sickness - Breast discomfort - Fatigue. Sign Breast changes- nipple and areola become more pigmented

Per abdomen:

Growth of adbomen during prenancy

Pelvic changes:
- Jacquemiers/ chadwicks sign: dusky hue of the vestibule and anterior vaginal wall visible at about 8th week of pregnancy( d/t local vascular congestion.pelvic tumour) - Vaginal sign: pulsation felt through the lateral fornics at 8th week called osianders - Cervical signs: cervix become soft as early as 6th week( goodells sign) - Uterine signs: hen eggs( 6th week) size of cricket ball at 8th week size of fetal head by 12 week when implantation is on lateral and asymmetrical enlargement of the uterus..PISKACEKS SIGN - HEGAR SIGN: can be demonstrated between 6-10 weeks, a little earlier in multiparae

upper part of the body of the uterus is enlarged by the growing fetus, lower part of the body is empty and extremely soft, the cervix is comparatively firm.

- palmers sign: Regular and rhythmic uterine

contraction can be elicited during examination as early as 4-8 weeks. bimanual

Pregnancy test

Selection of time: diagnosis of pregnancy by HCG

in maternal serum or urine can be made by 8 t0 11 days after conception.
Ultrasonography: intra decidual gestational sac is identified as early as 29-35 days of gestation

Second trimester(13-28 weeks): Symptoms: - Quickening: 18 week and 2 week earlier in multi. - Progressive enlargement of the lower abdomen - Chloasma at 24 week

- Breast changes: prominent vein, 20 areola, montgomerys tubercles prominent and extend to secondary areola - Colostrum become thick and yellowish by 16th week

Abdominal examination: -inspection: linea nigra 20 week

Striae gravidarum

The uterus feelssoft and elastic Braxton hicks contraction Palpation of fetal parts by 20th week Active fetal movement by 20 weeks External ballottement by 20 week

AUSCULTATION: By stethoscope 18-20 weeks( watch under a pillows). two sound are confused a. Uterine souffle: soft blowing and systolic murmur, best on left side. d/t to blood flow through the dilated uterine vessels b. Funic or fetal souffle: soft blowing and murmur synchronous with the fetal heart sounds, d/t rush of blood through the umbilical arteries.

Vaginal examination: bluish discolouration of the vulva, vagina and cervix. a. Internal ballottement: can be elicit between 16-28 weeks. The fetus is too small B4 16week and too large to displace after 28 weeks.

Last trimester( 29-40 weeks): symptoms: - amenorrhoea, enlargement of abdomen, lightening 38th weeks, frequency of micturition, fetal movement. Sign: -uterine shape is cylindrical to spherical by 36th week - Fundal height - Braxton hicks contraction are more evident - FHS base on position

DIFFERENTIAL DIAGNOSIS OF PREGNANCY: - Uterine fibroid - Cystic ovarian tumour - Encysted tubercular peritonitis - Haematometra - Distended urinary bladder Pseudocyesis: Pseudocyesis( psychological disorder) is the medical term for a false pregnancy. Pseudocyesis can cause many of the signs and symptoms of pregnancy, and often resembles the condition in every way except for the presence of a fetus.

Summary of diagnosis of pregnancy Positive signs of pregnancy are those signs that are definitely confirmed as a pregnancy. They include - fetal heart sounds, - ultrasound scanning of the embryo as early as 6th week, - palpation of the entire fetus, - palpation of fetal movements, - x-ray fetal skeleton at 16 week, and actual delivery of an infant. - Auscultation of FHS

Presumptive signs and symptoms of pregnancy are those signs and symptoms that are usually noted by the patient, which impel her to make an appointment with a physician. These signs and symptoms are not proof of pregnancy but they will make the physician and woman suspicious of pregnancy.
- Amenorrhea (Cessation of Menstruation) - Nausea and Vomiting (Morning Sickness). - Frequent Urination. - Breast Changes.

- Vaginal Changes.

Chadwick's sign. The vaginal walls have taken on a deeper color caused by the increased vascularity because of increased hormones. It is noted at the sixth week when associated with pregnancy

Leukorrhea. This is an increase in the white or slightly gray mucoid discharge that has a faint musty odor. It is due to hyperplasia of vaginal epithelial cells of the cervix because of increased hormone level from the pregnancy

- Skin Changes.

- Fatigue. This is a common complaint by most patients during the first trimester. Fatigue may also be a result of anemia, infection, emotional stress

Probable signs of pregnancy are those signs commonly noted by the physician upon examination of the patient. These signs include - uterine changes, - abdominal changes, - cervical changes, - basal body temperature, - positive pregnancy test by physician, and - fetal palpation - Changes in shape, size and consistency of the uterus. - Jacquemiers and osianders sign - Ballottement( e+i)

Bibliography
- Dutta page no 60-74 - http://www.brooksidepress.org/Products/Obstetric_and _Newborn_Care_1/lesson_3_Section_1A.htm