Diagnosis of Pregnancy

Diagnosis of pregnancy

First trimester

•         Symptoms

•  amenorrhea
• morning sickness
• frequency of micturition
• breast discomfort
• fatigue

•         Signs

• breast changes
• abdominal enlargement
• pelvic changes

•         Pelvic changes

• Jacquimier’s or Chadwick's sign
• discoloration of  vaginal mucosal membrane and thickening of vagina occurs (4 to 8 weeks)

•         Vaginal sign

• Copious non irritating mucoid discharge in the vagina

•         Cervical sign

• softening of the cervix occurs. (at 6^th week)
• Cervix becomes elastic  also known as Goodle s sign.

•         Uterine sign

• 6^th wk-hen’s egg
• 8^th wk-cricket ball
• 12^th wk-fetal head

•         Piskaceck’s sign

• Asymmetrical enlargement of the uterus

•         Hegar’s sign(6^th to 10^th week)

on bimanual examination ,that is   P V examination with right hand and abdomen with left hand, the examiner feels that both are touching because of extreme softening.

Immunological tests for diagnosis of pregnancy

A) immuno assay without radioisotope

•         Agglutination inhibition test

1)      pregnant

                  Urine containing HCG +  HCG antiserum

                        (1 drop)                   (contain ab)                            

                                       Neutralization of antibody

                                                    +

                                       HCG coated latex particle

                        no visible agglutination (test is positive)

2)      Non pregnant

                                   urine (no HCG) + HCG antiserum

                       

                                    No neutralization (antibody remains free)

                                                            +                                                                     

                                              HCG Coated latex particle

                                                   Visible agglutination

                                                          (test is negative)

Direct agglutination test

•         Here latex particle coated with HCG antiserum is added directly

•         If no  visible agglutination (test is positive)

ELISA

•         Sensitivity (if HCG >25mIU)

•         Time is 80 min

•         Post conceptional age when first positive(14 to 17 days)

•         Gestational age when first positive is(3.5 wks)

B) Immuno assay with radio isotope

1) radio immuno assay (RIA)

•         Sensitivity 5m I U

•         Time to complete3 to 4 hrs

•         Detect pregnancy as early as8 to 9 days after ovulation

2)immuno radiometric assay (IRMA)

•         Requires 30 min

•         Sensitivity150I U/ML

Advantages:

•         Accurate

•         Cheap

•         Less time consuming

Ultra sonography

•         Gestational sac is visible by 29 to 31 days

•         Fetal pole and cardiac activity by 6 weeks

•         fetal heart rate by 6^th week

2^nd trimester

•         Symptoms

•         Amenorrhea

•         Quickening

•         progressive enlargement of abdomen

•         Signs

•         Chloasma (cheeks and forehead)

•         Breast changes

•         Linea nigra

•         Striae gravidarum

•         Abdominal examination

•         Inspection

•         Palpation

•         Auscultation: Fetal heart sound(17^th  to 20^th wk)

•         Vaginal examination

•         USG

3^rd trimester

•         Symptoms

•         Amenorrhea persists

•         progressive enlargement of the abdomen(85-100cm)

•         Lightening

•         Frequency of micturition

•         fetal movements are pronounced

•         Signs

•         Cutaneous changes-increased pigmentation

•         Uterine shape

•         Fundal height

•         Braxton Hick’s contraction

•         Fetal movements are easily felt

•         Palpation of fetal parts are much easier

•        Fetal heart sounds heard (may not be audible, if maternal obesity, polyhydramnios, IUD)