This document discusses the diagnosis of pregnancy through various signs and symptoms presented in the three trimesters of pregnancy. It outlines the normal duration of gestation and describes common symptoms seen in each trimester such as cessation of menstruation, breast changes, nausea, and fetal movements. Diagnostic tests like urine and blood tests for hCG and ultrasound are mentioned. Common physical exam findings for each trimester including uterine size, fetal heart tone auscultation, and fundal height are summarized.

1. Diagnosis of pregnancy
Dr Fahmida Rashid
FCPS, MS(Gynae & Obs)
Assistant Professor
Dept. of Obs and Gynae
2019
Chattogram medical College

2. • Pregnancy :
• Maternal condition of
having a developing
fetus in maternal body.
• Usually between -15-45
yr of age.

3. • Normal duration of gestation:
• 40 completed wks/
• 10 lunar month/
• 9 month 7 days /
• 280 days
• Counted from 1st day of last menstrual period .
• Preterm-<37 wks
• Term-37-42 wks
• Post term: >42 wks

4. • 3 trimester
• 1st trimester –
1st 12 weeks
• 2nd Trimester-
13-28 weeks
• 3rd trimester –
29-40 weeks

5. • Diagnosis of pregnancy:
• Important .
• To Assure couple
• Prevent exposure
• To start ANC
• Diagnosis –
• begins when women present with symptom and
/ positive home urine pregnancy test

6. • Diagnosis in the first trimester
• Symptoms:
• 1. Cessation of menstruation :
• (missed period):
• due to ↑ E and P by the corpus Luteum.
•
• • Slight bleeding at expected time of
menstruation rarely occurs in the first 3
months (Hartman‘s sign / placental sign) –
scanty.
• • Shouldn’t get confused with -Threatened
abortion.

7. • 2. Nausea with or without vomiting
• “Morning sickness” –
• during the first three months
• PICA – craving for non-edible materials
• Hyperemesis gravidarum –
extreme nausea and vomiting associated with
hyperplacentosis, like multiple pregnancies or
molar pregnancy
• Correlates with levels of bHCG
• Peaks at 60-90 days
then disappears

8. • 3. Frequency of micturition:
• congestion of bladder mucosa.
• Irritation of the bladder by the pregnant
uterus.
• resting of bulky uterus on the bladder
(ante-verted position of the uterus).
• change in maternal osmoregulation  leads to
increased thirst and polyuria.
• - Usually disappears after the third month.

9. • 4.Breast symptoms:
• Enlargement , heaviness , discomfort and
pricking sensation
•  6th – 8th week
• specially in primigravidae.
• 5. Appetite changes:
• Craving for certain types of food and refusal of
other types.
• 6. Fatigue: - frequent symptom that may
occur in pregnancy and tendency to sleep

11. • 1. Breast signs :
• ( evident in a primigravida).
• 6 - 8 weeks
• ↑ size and vascularity-Dilated visible veins.
• ↑ pigmentation of the nipple and primary
areola.
• Appearance of secondary areola &
• Montgomery tubercles in the areola
• Expression of colostrum (thick yellowish
secretion) – as early as 12th week

14. • PER ABDOMEN:
• Uterus - pelvic organ until 12th week,it may
be just felt per abdomen a suprapubic bulge.
• PELVIC CHANGES:
• JACQUEMIER’S OR CHADWICK’S SIGN
• OSIANDER’S SIGN
• GOODELL’S SIGN

15. • JACQUEMIER’S
SIGN/Chadwick’s sign :
• Dusky hue
• visible at 8th week
• More pronounced as
pregnancy advances and
is more definitely
present in multiparae.
• Due to local vascular
congestion.

16. • OSIANDER’S SIGN
• • Increased pulsation ,
• felt through the lateral fornices
• at 8th week.

17. • GOODELL’S SIGN
• Cervix becomes soft as early as 6th week
• Softening is more surrounding the external os
and also in the upper part.
• The pregnant cervix feels like the lips of the
mouth.
• P/S/E:
The bluish discolouration
of the cervix is visible 
due to the increased
vascularity.

19. • – Hegar sign : ( between 6-10 weeks).
• Two fingers in the anterior fornix, the fingers of the
other hand over the abdomen behind the uterus .
• The fingers of both hands can be approximated as the
lower part of the uterine body is soft and empty.
• Palmer sign: Uterine contractions felt on bimanual
examination.
•Uterine sign ;
• felt by B/M/E:
• Size : enlarged.
•consistency : soft.
• Shape : globular.

21. HCG
• This hormone released by trophoblastic tissue
produced by a growing fetus and its
associated placenta.
• hCG is present in maternal circulation as
either an intact dimer, alpha or beta subunit,
and degraded form, or beta core fragment
• Detection of HCG in maternal serum and urine
is evident only 8- 10 days after conception.

22. • hCG detectable in serum of
• In 5% -8 days after conception and
• in > 98% - by day 11
• Diagnostic levels in Urine seen only about
23-24 days after conception.
• Levels peak at 10-12 weeks' gestation and
then plateau before falling.

24. In general ,HCG level will be double every 2-3 days in
early pregnancy

25. Blood test for HCG:
Used only in special cases(BOH,Suspected Ectopic)
Require special lab and expertise.
• 4 main hCG assays are used,
• (1) radioimmunoassay,
• (2) immunoradiometric assay,
• (3) ELISA
• (4) fluoroimmunoassay.

26. • Radioimmunoassay :
• Gestational age when
first positive - 3-4
weeks Immunoradiometric
assay :
Less sensitive
Gestational age when
first positive - 4 weeks

27. • ELISA
• (More sensitive)
• Gestational age
when first positive -
4 weeks
•Fluoroimmunoassay
•Gestational age when
first positive - 3.5 weeks

29. • ULTRASOUND
• Intra decidual gestational sac is
identified as early as 29 – 35 days
of gestation
• Gestational sac & yolk sac -5
menstrual weeks
• • Fetal pole and cardiac activity –
6 weeks
• Embryonic movements -7 weeks
• Doppler effect of US can pick
heart rate reliably by 10th week.

30. Diagnosis in the second trimester
• Symptoms:
• 1. Amenorrhea.
• 2. Morning sickness and urinary
symptoms - .
• 3. “Quickening “ :
• a. 18-20 weeks in primigravida.
• b. 16-18 week s in multipara.
• 4. Abdominal enlargement.

31. • INSPECTION: –
Linea nigra
extending from
symphysis pubis
to ensiform
cartilage
•  20th week…
ABDOMINAL EXAMINATION:

32. • STRIAE
• ( both pink and
white)
• visible in the lower
abdomen
• more towards the
flanks

33. • • PALPATION: –
Fundal height –
• increased with
progressive
enlargement of the
uterus.

34. • 1. The uterus is abdominally felt (ovoid).
feels soft and elastic
• 2. Braxton Hicks contractions;
• intermittent painless contractions in P/A/E.
• 3. Active fetal movements :by placing the hand
over the uterus as early as 20th week.
•
• 4. External ballottement : elicited at 20 week
through abdominal examination.
• 5. Palpation of the fetal parts and
• palpation of fetal movements by the obstetrician
at 20 weeks.

36. • Auscultation:
• • as early as 20-24 weeks by Pinard
stethoscope
• • Auscultation of funic/fetal souffle  due to
rush of blood through the umblical artery
• • Auscultation of uterine souffle
• (soft blowing and systolic murmur heard low
own at the sides of the uterus)
•  synchronous with the maternal pulse

39. • INVESTIGATIONS…
• • SONOGRAPHY: –
• Routine at 18 – 20 weeks
- detailed survey of fetal anatomy,
- placental localisation and
- integrity of the cervical canal.
• FETAL ORGAN
ANATOMY :
– To detect any
malformation.
• FETAL VIABILITY

40. Diagnosis in the third trimester
• • SYMPTOMS:
• – Amenorrhoea persists
• – Enlargement of the abdomen
•  leading to discomfort to the patient
(palpitaion or dyspnoea following exertion)
• – LIGHTENING: 38th week
•  sense of relief of the pressure symptoms
due to engagement of the presenting part.

41. • Frequency of micturition reappears
• – Fetal movements are more pronounced.

42. • SIGNS:
• – Cutaneous changes are
more prominent with
increased pigmentation &
striae.
• – Uterine shape – from
cylindrical to spherical
beyond 36th week

44. • – FUNDAL HEIGHT
• (distance between the umbilicus and ensiform
cartilage)

45. • SYMPHYSIS FUNDAL HEIGHT:
• – Upper border of the fundus located by ulnar
border of the left hand and point is marked.
• – Distance between the upper border of the
symphysis pubis upto the point marked is
measured in centemetre
• – After 24 weeks, the SFH in cm corresponds
to the number of weeks upto 36 weeks.
• • Braxon-Hicks contraction – more evident
• • Fetal movements – easily felt

47. • • Palpation of the fetal
parts and their
identification become
much easier.
• • F.H.S – heard distinctly

48. • • SONOGRAPHY:
• – Fetal growth assessment can be made more
accurate.
• • Amniotic fluid volume assessment – for oligo
/ poly.

49. • Manifestation of pregnancy:
1.Presumptive
2.Probable
3. Positive

50. • Presumptive signs
a) Amenorrhea
b) Thermal signs
c) Anatomic breast
changes
d) Skin pigmentation
changes
e) Changes in vaginal
mucosa
Presumptive symptoms
a) Nausea with or without
vomiting
b) Disturbance in
urination
c) Fatigue
d) Maternal perception of
fetal movement
e) Breast symptoms
1. Presumptive evidence of pregnancy •

51. • 2. Probable evidence of pregnancy
• • Enlargement of the abdomen
• • Changes in the size, shape and consistency
of the uterus
• • Anatomical changes in cervix
• • Braxton-Hick’s contractions
• • Ballottement
• • Physical outlining of the fetus
• • Positive results of endocrine tests

52. • 3. Positive evidence of pregnancy
• • Identification of fetal heart tones
• • Perception of fetal movement by the
examiner
• • Recognition of embryo or fetus by
ultrasound imaging

53. 1. Presumptive evidence:
may resemble pregnancy; very non-
specific
2. Probable evidence:
indicate pregnancy the majority of the time.
They can be false or caused by something
other than pregnancy
3. Positive signs:
guarantees pregnancy;

55. • UTERINE FIBROID
• • CYSTIC OVARIAN TUMOUR
• (Amenorrhoea absent firm, hard, positive sign
absent, USG)
• • ENCYSTED TUBERCULAR PERITONITIS
• (H/O Koch’s infection, swelling ill defined,
positive signs absent, USG)
• • HAEMATOMETRA
• • DISTENDED URINARY BLADDER
(Catheterisation solves the problem)
• • PSEUDOCYESIS