Diagnosis of Pregnancy

Symptoms and Signs

• Amenorrhea

  • other causes

    • hypothalamic-pituitary-ovarian axis disturbance

    • recent use of contraceptive pill

  • may continue to bleed up to 12 weeks ("decidual bleeding")

• Nausea

  • early months of pregnancy

  • ?oestrogen, HCG

  • reduced gastric motility

  • relaxation of lower oesophageal sphincter

• Bladder symptoms

  • Frequency

  • 2nd and 3rd months

  • increased vascularity and pressure from enlarging uterus

  • near term from pressure of foetal head

• Breast

  • 6 weeks

    • increased vascularity

    • sensation of heaviness

  • 8 weeks

    • increased pigmentation of areola

  • Montgomery's tubercles

  • 16 weeks

    • colostrum secreted

  • 20 weeks

    • secondary areola prominent

• Uterus

  • on bimanual examination at 7-8 weeks

  • 7 weeks - large hens egg

  • 10 weeks size of orange

  • 12 weeks size of grapefruit, palpable abdominally

  • 16 weeks mother aware of increase in abdominal size

• Cervix

  • softening

  • bluish discolouration due to increased vascularity

• Awareness of fetal movements

  • 16-18 weeks parous women, 18-21 in primigravida

• Uterine contractions (Braxton Hicks')

  • painless

  • from week 9/10 onwards

  • palpable from week 20

• Auscultation of fetal heart

  • from about 24-26 weeks with Pinard stethoscope

  • from 12-14 weeks with Doppler

• Palpable fetal parts

  • from about 26 weeks

• Skin Changes

  • face (chloasma)

  • abdomen (linea nigra)

  • striae gravidarum

Investigations

• beta-HCG

  • detectable in urine by date of first missed period (25U/l)

• Ultrasound

  • gestational sac visible after 5-6 weeks of amenorrhoea

  • TV USS can identify foetus at 5 weeks

  • TA USS  - crown rump length measurable after 7 weeks to give dates

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