Вы находитесь на странице: 1из 26

Pink Unit

-Dr. Mounika
-Dr. Ramadevi
Subjective symptoms
 Amenorrhea

Amenorrhea during the reproductive period of an

otherwise healthy individual having previous
normal regular cycles is likely due to pregnancy,
unless proved otherwise
 Morning sickness

 Frequency of micturition : 8- 12th week

 Breast discomfort : 6- 8th week

 Fatigue
Objective signs
 Breast changes (primigravidae) : 6- 8 weeks
 Enlargement with vascular engorgement
 Nipple and the primary areola become more
 Colustrum can be expressed as early as 12th

 Per Abdomen
 Uterus remains a pelvic organ till 12 weeks
Pelvic Changes
 Vaginal changes
 Jacquemier’s or Chadwick’s sign : dusky hue of
the vestibule and the anterior vaginal wall (at
about 8th week)
 Osiander’s sign : increased pulsations felt
through the lateral fornices (at 8th week)

 Cervical changes
 Goodell’s sign : cervix becomes soft (as early as
6th week)
 Bluish discoloration of the cervix
 Uterine changes
 Size, shape and consistency of the uterus
(Piskacek’s sign : In a case of lateral implantation
of the embryo, one half of the uterus becomes
more firm than the other)
 Hegar’s sign : 6- 10 weeks
On bimanual examination, the abdominal and
vaginal fingers seem to appose below the body of
the uterus
 Palmer’s sign : 4- 8 weeks
Regular and rhythmic uterine contractions
elicited during bimanual examination
Immunological tests
 Principle : detection of hCG antigen present in
the maternal urine or serum with antibody
 Selection of time : diagnosis by detecting hCG
in maternal urine or serum can be made by 8
to 11 days after conception. The test is not
reliable after 12 weeks
 Collection of urine : first voided urine in the
Test Sensitivity Time taken Inference Positive on
Agglutination 0.5- 1 IU/ml 2 min Absence of 2 days after
inhibition test (Urine) agglutination missed period
Direct latex 0.2 IU/ml 2 min Presence of 2- 3 days after
agglutination (Urine) agglutination missed period
Two-site 30- 50 4- 5 min Colour bands On the fist day
sandwich mIU/ml in the control of the missed
immunoassay/ (Urine) as well as in period (28th
Membrane ELISA test windows day of cycle)
test (Card test)
ELISA 1- 2 mIU/ml 2- 4 hours 5 days before
(Serum) the first
missed period
Fluoroimmuno 1 mIU/ml 2- 3 hours “
assay (FIA) (Serum)
Radioimmuno 0.002 mIU/ml 3- 4 hours 25th day of
assay (RIA) (Serum) cycle
Immuno 0.05 mIU/ml 30 min 8 days after
radiometric (Serum) conception
assay (IRMA)
 Intradecidual gestational sac is identified as
early as 29- 35 days of gestation
 Embryonic structures identified by TVS

Menstrual/ Fetal structures

gestational age
4 Choriodecidual thickness, chorionic
5 Gestational sac, embryo yolk sac
6 Fetal pole, cardiac activity
7 Lower limb buds, midgut herniation
8 Upper limb buds, stomach
9 Spine, choroid plexus
 Amenorrhea continues
 Quickening : about 18th week in primi and
16th week in multi
 Progressive enlargement of the lower
abdomen by the growing uterus
General examination
 Chloasma : pigmentation over the forehead
and cheek (at about 24th week)

 Breast changes:
 Breasts are more engorged with prominent
 Secondary areola appears at about 20th week
 Montgomery’s tubercles are prominent and
extend upto secondary areola
 Variable degree of striae
Abdominal examination
 Inspection:
 Linea nigra as early as 20th week
 Striae on the flanks

 Palpation:
 Fundal height
 Braxton- Hicks contractions are evident
 Palpation of the fetal parts (by 20th week)
 Active fetal movements (by 20th week)
 External ballotment (by 20 th week)
 Ausculatation:
 Fetal heart sounds (most conclusive clinical
sign of pregnancy): detected by 18- 20 weeks
with a stethoscope
Differential diagnosis:
 Uterine souffle – synchronous with maternal
 Funic or fetal souffle – synchronus with fetal
heart souds
 Vaginal examination
 Bluish discoloration of the vulva, vagina and
cervix is more evident, so is softening of the
 Internal ballotment: 16- 28th week
Imaging studies
 Sonography
 Gestational age is determined by measuring
BPD, HC, AC and FL and is most accurate
between 12- 20 weeks
 Detailed survey of fetal anatomy at 18- 20
 Radiological evidence of fetal skeletal shadow
by 16th week
 Amenoorhea persists
 Enlargement of the abdomen
 Lightening
 Frequency of micturition
 Fetal movements
 Cutaneous signs
 Fundal height: increases and decreases back
to 32 week size with head engaged and flank
 Symphysiofundal height: measured in cms
(corresponds to gestational age from 24
weeks to 36 weeks)
 Braxton- Hicks contractions
 Fetal parts and fetal movements
 Fetal Heart Sounds
 Gestational age estimation is less accurate
(variation of 3 weeks)
 Fetal growth profile by AC (IUGR or
 Amniotic fluid volume assessment
 Uterine fibroid
 Hematometra
 Cystic ovarian tumour
 Encysted tubercular peritonitis
 Distended urinary bladder
 Pseudocyesis (false/ spurious/ phantom
Psychological disorder where the woman has the
false but firm belief that she is pregnant
although no pregnancy exists
 Conspicuous feature is cessation of menstruation
 Gradual enlargement of abdomen because of
deposition of fat
 Secretions from breast
 Intestinal movements, interpreted as fetal
 Eventually spurious labour
Obstetric examination, imaging and the
immunological tests for pregnancy negate the
presence of any pregnancy
Positive or absolute signs:
 Palpation of feta parts and perception of
active fetal movements by the examiner
 Ausculation of fetal heart sounds
 Ultrasound evidence of embryo and fetus
 Radiological demonstration of fetal skeleton
Probable signs:
 Abdominal enlargement
 Braxton- Hicks contractions
 External and internal ballotment
 Outlining of fetus
 Changes in the size, shape and consistency of
the uterus
 Vaginal and cervical changes
 Immunological test
Presumptive signs and symptoms
 Amenorrhea
 Frequency of micturition
 Morning sickness
 Fatigue
 Breast changes
 Skin changes
 Quickening