1. DIAGNOSIS OF
PREGNANCY
PRESENTED BY :
MS. VRUTI PATEL,
F.Y.M.SC. NURSING,
SCN

2. INTRODUCTION
Presumptive signs
Probable signs
Positive signs

3. DIAGNOSIS THE PREGNANCY
In first trimester
In second trimester
In third trimester

4. FIRST TRIMESTER (FIRST 12 WEEKS)
Subjective Sentence
 Amenorrhoea – Abrupt cessation of
menstruation at 4th week
 Morning sickness (Nausea and vomiting) from
4th – 14th week
 Frequency of micturition (Bladder irritability
 Breast discomfort
 Fatigue

5. Objective sign
• Breast changes - valuable only in primigravidae
• Per abdomen
• Pelvic changes
• Jacquemier’s or chadwick’s sign
• Vaginal sign
• Cervical signs - as early as 6th week (Goodell’s
sign)
• Uterine signs : (a) Size, shape and consistency
(b) Hegar’s sign
(c) Palmer’s sign

6. IMMUNOLOGICAL TESTS FOR
DIAGNOSIS OF PREGNANCY
• Principle : Pregnancy tests depend on
detection of the antigen (hCG) present in
the maternal urine or serum with antibody
either polyclonal or monoclonal available
commercially.

7. (A) Immuno assays without radioisotopes
• Agglutination inhibition tests – Using latex
(L.A.I.)
• Principle of agglutination inhibition tests
• Direct agglutination test (hCG direct test)
• Enzyme-linked immunosorbent assay (ELISA
• Fluoroimmuno assay (FIA)

8. (B) Immuno assay with radiosotopes
• Radioimmunossay (RIA) - used for determining
the doubling time of hCG (ectopic pregnancy
monitoring)
• Immuno-radiometric assay (IRMA) - detect
hCG as low as 0.05 mIU/ml
Selection of time
Collection of urine
Other uses of pregnancy tests
Ultrasonography

9. SECOND TRIMESTER (13-28 WEEKS)
Symptoms :
• subjective symptoms –such as nausea,
vomiting and frequency of micturition usually
subside
• Quickening (feeling of life)
• Progressive enlargement of the lower
abdomen

10. General Examination
o Chloasma : Pigmentation over the forehead and
cheek
o Breast changes - enlarged with prominent veins,
Secondary areola, Montgomery’s tubercles are
prominent and extended, Colostrum

11. o Abdominal examination
• Inspection
• Palpation
• Auscultation - Uterine souffle - soft blowing and
systolic murmur heard low down at the sides of the
uterus, best on the left side; Funic of fetal soufflé is due
to rush of blood through the umbilical arteries

12. o Vaginal Examination
• The bluish discolouration
• Internal ballottement

13. o Investigations
• Sonography
• Fetal organ anatomy
• Magnetic Resonance Imaging (MRI

14. LAST TRIMESTER (29-40 WEEKS)
Symptoms
(1) Amenorrhoea persists
(2) Enlargement of the abdomen is progressive
(3) Lightening – At about 38th week
(4) Frequency of micturition
(5) Fetal movements

15.  SIGNS
• Cutaneous changes
more prominent with
increased pigmentation
and striae
• Uterine shape
changed from cylindrical
to spherical beyond 36th
week.

16. • Fundal height • Symphysis fundal
height (SFH) The
upper border of the
fundus is located by the
ulnar border of the left
hand and this point is
marked

17. • Braxton-Hicks
contractions are more
evident.
• Fetal movements are
easily felt

18. • Palpation of the fetal
parts
• FHS

19. • Sonography

20. DIFFERENTIAL DIAGNOSIS
• Uterine Fibroid,
• Cystic Ovarian Tumour,
• Encysted Tubercular Peritonitis,
Haematomata
• Even Distended Urinary Bladder, etc.