Chapter 4 diagnosis of Chapter 4 diagnosis of pregnancypregnancy

phasesphases ： ≤： ≤ 12w early phase 12w early phase 13w--27w middle phase13w--27w middle phase ≥ ≥28w late phase28w late phase sec.1 diagnosis of early phasesec.1 diagnosis of early phase sec.2 diagnosis of mid/late phase sec.2 diagnosis of mid/late phase sec.3 lie,presentation and sec.3 lie,presentation and

positionposition

Sec.1 diagnosis of early Sec.1 diagnosis of early phasephase

[history and symptom][history and symptom] 1.1.cessation of mensescessation of menses:in a healthy married :in a healthy married

woman who has previously menstruated woman who has previously menstruated regularly,cessation of menstruation strongly regularly,cessation of menstruation strongly suggests the pregnancy.the date of expected suggests the pregnancy.the date of expected period has been passed by 10 days or more,the period has been passed by 10 days or more,the likelihood of pregnancy is indicated.when the likelihood of pregnancy is indicated.when the second period is also missed the probability second period is also missed the probability naturally becomes stronger.but absence of naturally becomes stronger.but absence of menstruation may result from a number of menstruation may result from a number of conditions other than pregnancy,such as psychic conditions other than pregnancy,such as psychic influence,anemia and breast-feeding period.influence,anemia and breast-feeding period.

2.2.morning sicknessmorning sickness:the establishment of :the establishment of pregnancy is frequently manifested by pregnancy is frequently manifested by disturbancesdisturbances

Of the digestive system,the morning sickness usually Of the digestive system,the morning sickness usually comes in the early part of gestation,about the end of comes in the early part of gestation,about the end of the first month and disappears 6 or 8 weeks later, altthe first month and disappears 6 or 8 weeks later, although some patients suffer from it for a long period, hough some patients suffer from it for a long period, that is “that is “hyperemesis gravidarumhyperemesis gravidarum”.”.

33.urinary disturbance.urinary disturbance:in the early weeks the enlargin:in the early weeks the enlarging uterus by exerting pressure on the bladder may caug uterus by exerting pressure on the bladder may cause a desire for frequent micturition.this continues fose a desire for frequent micturition.this continues for the first months and gradually passes off as the uterr the first months and gradually passes off as the uterus rises up into the abdomen,to reappear when the hus rises up into the abdomen,to reappear when the head descends into the pelvis a few weeks before deliead descends into the pelvis a few weeks before deliveryvery

〔 physical exam. and signs 〕 .. 1.1.breastsbreasts:enlargement,pigmentation of nipples and :enlargement,pigmentation of nipples and

areola surrounded by Montgomery tubercles.areola surrounded by Montgomery tubercles. 2.2.reproductive tractreproductive tract..

(1)coloration of the mucous membrane of vagina vul(1)coloration of the mucous membrane of vagina vulva.va.

(2)(2)Hegar Hegar signsign:on careful vaginal examination,the firm,:on careful vaginal examination,the firm, hard cervix is felt and above it the elastic corpus, bet hard cervix is felt and above it the elastic corpus, between the two the isthmus is felt as a soft compressiblween the two the isthmus is felt as a soft compressible area.occasionally the change is so marked that as if e area.occasionally the change is so marked that as if no connection exists.no connection exists.

(3)(3)enlargement of uterusenlargement of uterus:during the first two months :during the first two months the uterus continues to be entirely a pelvic organ, whthe uterus continues to be entirely a pelvic organ, whereas during the third month it begins to rise above tereas during the third month it begins to rise above the symphysis into abdominal cavity.he symphysis into abdominal cavity.

〔 accessory exam. 〕 1.ultrasonography.1.ultrasonography. (1) (1) B-usB-us:as early as 5w,the gestational ring can be see:as early as 5w,the gestational ring can be see

n ,with heart-beat and movement of fetus. n ,with heart-beat and movement of fetus.

(2)(2)DopplarDopplar-us-us:as early as 7w,the fetal heart sound c:as early as 7w,the fetal heart sound can be heard.an be heard.

2.gestational assay:2.gestational assay:β-hcG≥25u/L in urine. 3.cervical discharge smear:ellipsoid. 4.progesterone assay:not in use. 5.basal temperature:with a cessation of menses,a hi

gher level of temperature for 3w or more which will indicate the pregnancy.

6.DD. Ovarian cyst,myoma,urine retention. Sec.2 diag. Of mid and late phases 〔 history and symptom 〕 :with the history of early

phase ;the feeling of the enlargement of abdomen and movement of fetus.

〔 physical exax. and sign 〕

1.1.enlargement of uterusenlargement of uterus::relative height of the fundus relative height of the fundus at the various lunar months of pregnancy.at the various lunar months of pregnancy.

2.fetal movement;from 5m,3-5t/min.2.fetal movement;from 5m,3-5t/min. 3.fetal heart beat:from the 18th/20th m,120-160bpm.3.fetal heart beat:from the 18th/20th m,120-160bpm. 44..fetal bodyfetal body:head,back,buttock,extremities.:head,back,buttock,extremities. 〔 accessory exam. 〕 1.B-us:of great importance for confirming the fetal po

sition,the developing state,the site of placenta and the quantity of amniotic fluid.

2.fetal ECG:not in use.3. NST. Sec.3 lie,presentation and position of fetus. ( 一 )fetal lie:the relation which the long axis of the fet

us bears to that of the mother.we dis- -tinguish between longitudinal and transverse.

(( 二二 ))fetal presentationfetal presentation DEF-:the part of the DEF-:the part of the fetus occupying the fetus occupying the lower pole of the ut-lower pole of the ut- -erus,-erus,

fetal positionfetal position:the relation of some arbitrarily chos:the relation of some arbitrarily chosen portion of the fetus to the right/left side of the men portion of the fetus to the right/left side of the maternal pelvis.the occiput,chin,sacrum and scapular aternal pelvis.the occiput,chin,sacrum and scapular being the determining being the determining points inpoints in vertex,face,breech a vertex,face,breech and shoulder presentations respectively.nd shoulder presentations respectively.

Fetal lieCephalic breech shoulderCompound presentation

Hegar

B-ultrasonograghy for early phase

Basal temperature

ovulation

fertilization

menstruation

Abdominal palpation

Presentation of fetus

Relative height of fundus at various lunar months of pregnancy

Vaginal touch

Fetal lie

Longitudinal lie transverse

Cephalic presentation

occipital vertex brow face

Breech presentation

complete frank Single footling footling

Compound presentation

Post-fontanell

Ante-fontanell

BPD

Sagittal suture

parietal

occipital

Frontal suture

Coronary suture

9.3cm

position

LOA LOP LOT

ROA ROP ROT

LSA LSP

RSA RSP

LMA LSP

RMA RMP

transverseLOAROA

LSARSA

Enlargement of uterus