Early Pregnancy Diagnosis and Testing

Early Pregnancy Diagnosis

• Symptoms: Amenorrhea, morning sickness, urinary symptoms, breast tenderness, weight gain, depression, and insomnia.
• Signs: Breast changes, vulval signs, vaginal signs, enlarged cervix, and enlarged uterus.

Pregnancy Test

• HCG Detection: Tests rely on detecting human chorionic gonadotropin (HCG) in urine or blood serum.
• False Negative: Diluted urine or testing too early can cause a false negative result.
• False Positive: Several factors can cause a false positive result, including proteinuria, choriocarcinoma, SLE, hematuria, and TB.

Early Pregnancy Test Timing

• Urine: Positive result at 35 days from the last menstrual period (LMP), or 5 days after the missed period.
• Serum: Positive result 8-10 days from ovulation or at day 25 from LMP.

Mid-Pregnancy Diagnosis (2nd trimester 13-28 weeks)

• Symptoms: Amenorrhea, breast symptoms, progressive abdominal enlargement, quickening (first fetal movement), and abdominal palpation of the uterus.
• Signs: Breast changes, skin signs, uterine signs (Braxton Hicks contractions), and uterine souffle.

Braxton Hicks Contractions

• Intermittent, painless contractions felt in the abdomen.
• Play a role in uterine development and placental circulation.

Fetal Signs in Mid-Pregnancy

• 24 Weeks: Palpation of fetal parts and fetal movement.
• 20 Weeks: Auscultation of fetal heart sounds (FHS) by Pinard.
• Umbilical Souffle: Auscultated due to rush of blood in the umbilical artery.
• Ballottement: Feeling of fetal movement upon palpation.

Role of Ultrasonography in Mid-Pregnancy

• Number of fetuses
• Fetal lie
• Fetal presentation
• Fetal position
• Fetal death or viability
• Placenta and cord
• Fetal size

Sure Signs of Mid-Pregnancy

• Inspection of fetus
• Palpation of fetus
• Palpation of fetal parts
• Auscultation of fetal heart sounds
• Auscultation of umbilical souffle
• Ultrasonography

Value of Auscultation

• Sure sign of pregnancy
• Diagnose fetal lie, presentation, position, and location
• To follow-up progress

Fetal Heart Sounds (FHS)

• Range: 110-160 bpm

Late Pregnancy Diagnosis (29-40 weeks)

• Role of Ultrasonography: Number of fetuses, fetal lie, presentation, position, death, placenta and cord (flow velocity), and fetal size.

Sure Signs of Late Pregnancy

• Inspection of fetal movement
• Palpation of fetal movements
• Palpation of fetal parts
• Auscultation of FHS
• Auscultation of umbilical souffle
• Ultrasonography showing fetal shadow

Value of Auscultating FHS in Late Pregnancy

• Sure sign of pregnancy
• Diagnose Intrauterine Fetal Death (IUFD)
• Diagnose twin pregnancy
• Diagnose Fetal Distress
• Know fetal position and presentation
• Follow-up labor progress

Maternal Changes with Pregnancy

• Weight Gain: Increase of approximately 25% of non-pregnant weight, or about 12.5 kg in average women, primarily occurring in the second half of pregnancy.
• Uterine Size, Shape, and Position: Uterus initially retains its pear shape but changes to globular and then ovoid with increasing size. It rises out of the pelvis, displacing intestines, and usually rotates to the right.
• Height: Increases from [measurement missing]
• Weight: Increases from [measurement missing]
• Endometrium: Highly vascular
• Lower Uterine Segment: [description missing]
• Upper Uterine Segment: [description missing]
• Membranes: Capacity of 4- [measurement missing], brief contractility, and pro[consistency unspecified]
• Utero-placental Diameter/Length: [measurement missing]
• Uterine Blood Flow: 500 ml/minute

Uterine Anatomy and Physiology

• Uterus During Pregnancy: Height increase to 35 cm at term, weight increase to 1000 grams at term, endometrial thickening, and division into upper and lower segments.
  • Upper Uterine Segment: Active during labor, contracts and retracts, has three muscle layers, and is covered by adherent peritoneum. Membranes are firmly attached.
  • Lower Uterine Segment: Passive during labor, dilates and stretches, has a thinner wall, is covered by loose peritoneum, and membranes are loosely attached.
• Uterine Changes in Pregnancy: Capacity increases to 1000 ml, Braxton Hicks contractions present, and consistency progressively softer.
• Blood Flow: Uterine and ovarian vessels increase in diameter and length. Uterine blood flow increases to 500 ml/minute at term.

Changes in the Cervix During Pregnancy

• Softens, becomes bluish, and swollen.
• Mucus glands produce a mucus plug that is expelled during labor.
• Increased vascularity affects the vagina, resulting in a violet color (Chadwick's sign).

Changes in Breasts During Pregnancy

• Hormonal Stimulation: Estrogen, progesterone, and human placental lactogen cause bilateral changes.
• Size Increase: Gradual increase in breast size.
• Appearance: Breasts become full, heavy, and enlarged in the second and third trimester.
• Sensitivity: Breasts may be sensitive or tender.
• Fluids: Pre-colostrum (thin, clear fluid) produced around 6 weeks, colostrum (thick, yellowish liquid) produced after the first few months.
• Other Changes: Increased blood volume, circulation, and vascularity. Primary areola becomes pigmented, nipples enlarge and become erectile, secondary areola appears around the fifth month, and Montgomery glands become hypertrophic.

Changes in Blood Volume During Pregnancy

• Maternal blood volume increases, including white blood cell volume.
• Red blood cell volume decreases slightly, resulting in "physiological anemia of pregnancy".
• Cardiac output increases by approximately 20%.
• Pulse rate increases due to larger stroke volume and muscle hypertrophy.
• Blood pressure may slightly decrease then increase by around 140/90 mm Hg.

Blood Volume Changes: More Detail

• Plasma volume increases by 40-50%, red blood cell volume increases by 15-20%.
• This creates "physiological anemia of pregnancy", where blood viscosity decreases by approximately 20%.

Cardiac Output in Pregnancy

• Cardiac output increases due to larger stroke volume and slightly increased pulse rate.
• Output increases rapidly in the first trimester (up to 40%) and stabilizes for the rest of the pregnancy.

Blood Pressure in Pregnancy

• Slight drop in the second trimester due to the opening of arterio-venous shunts at the placenta.
• Elevated BP if: Rise of 140/90 mm Hg or more on two occasions (6 or more hours apart), or a rise in systolic BP of 30 mm Hg or diastolic BP of 15 mm Hg.

Supine Hypotension Syndrome

• Occurs in 10% of women, caused by uterine compression of great vessels.
• Causes significant arterial hypotension.
• Also occurs with hemorrhage or spinal analgesia.

Heart Changes in Pregnancy

• Enlarged, pushed up, and unfolded upon aorta.
• Produces normal ECG and X-ray changes for pregnancy.

Volume Homeostasis in Pregnancy

• Fluid retention is a fundamental systemic change.
• Total blood volume increases by 30%.

Pregnancy-induced Hypervolemia

• Functions to meet metabolic demands of the enlarged uterus, provide nutrients to the placenta and fetus, and protect mother and fetus against impaired venous return.

Dermatological Changes in Pregnancy

• Linea Nigra: Dark line from pubis to umbilicus, fades after delivery but may not disappear completely.
• Mask of Pregnancy (Chloasma): Brownish hyperpigmentation of face and forehead, intensifies and then fades after childbirth.
• Striae Gravidarum (Stretch Marks): Stretch marks from separation in the underlying connective tissue, fade after childbirth but may not disappear completely.

Respiratory Changes in Pregnancy

• Diaphragm: Rises approximately 4 cm.
• Subcostal Angle: Widens.
• Thoracic Circumference: Increases by 6 cm.
• Diaphragmatic Excursion: More pronounced in pregnant women.

Gastrointestinal (GIT) Changes in Pregnancy

• Appetite: Increased, sometimes with cravings.
• Progesterone: Relaxes lower esophageal sphincter, increasing reflux and heartburn.
• Gastrointestinal Motility: Reduced, slowing transit time, increasing nutrient absorption but also constipation risk.
• Gallbladder: May dilate and empty less completely, increasing cholesterol gallstones risk.
• Gums: Become spongy, friable, and prone to bleeding; good dental care is important.

Urinary Changes in Pregnancy

• Blood Volume & Cardiac Output: Increased renal blood flow and glomerular filtration rate (GFR).
• Excretion & Blood Levels: Increased excretion and reduced blood levels of urea, creatinine, urate, and bicarbonate.
• Plasma Osmolality: Reduced due to increased water retention.
• Glycosuria & Proteinuria: Possible due to GFR exceeding kidney's reabsorption capacity.
• Bladder: Smooth muscle relaxes, increasing bladder capacity and UTI risk.

Placenta

• Function: Acts as a temporary organ, produces hormones (progesterone), supports fetal growth.
• Growth: Increases in size and length.

Additional Notes

• 5% of pregnancies are asymptomatic.
• Pyelonephritis (kidney infection) is a potential complication.

This quiz covers the signs and symptoms of early pregnancy, the role of HCG in pregnancy tests, and the timing for positive results from both urine and serum tests. It also touches upon factors that can lead to false positive and negative testing results. Enhance your knowledge and understanding of early pregnancy detection.