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Revision

Diagnosis of Early Pregnancy


Manifestations
A.Symputoms:
Amenorrhea ;
Nausea with or without vomiting(morning sickness)
Urinary frequency and urgency;
Pain slightly in the breast,
0ther symputoms :Uterine bleeding
B.Signs:
Montgomery;
Hegar’s sign;
Helpful Examinations
A.Clinical test
B.Pelvic ultrasonography
C. Basal body temperature ( BBT )
D. Pregestin test
E. Cervical mucus examination
Differential diagnosis
A. Myomas
B. Ovarian tumor
C. Ectopic pregnancy
Diagnosis of the second and third Trimester
of pregnancy
Manifestations
A.Symputoms: Amenorrhea ;
Disturbance in urination;
Perception of fetal movement
B.Presumptive Signs:
Breast changes ;
Discoloration of the vaginal mucosa ;
Increased skin pigmentation and appearance of abdominal striae
C.Probable evidence of pregnancy:
Enlargement of the abdomen;
Chan ges in size,shape ,and consistency of the uterus;
Braxton Hicks Contraction ;
Ballotement
D.Positive signs of pregnancy:Fetal heart action
Fetal movement by sonography
Recongnition of the fetal in the uterus cavity by sonography
Revision

Helpful Examinations:
Clinical test;
Ultrasonography
Differential diagnosis of pregnancy:
Myomas;
Ovarian tumor

Other examinations:
fetal lie ;
fetal presentation ;
fetal position
Lecturer: Liu Wenhui
Sophie liu
The Department of Gynecology &
Obstetrics in Zhongnan Hospital
Early pregnancy

The second trimester and the

third trimester
Introduction
Contents
 History
 Physical examination
 Laboratory tests
 Advice to paients
 Tests & precedures
 Nutrition in pregnancy
History
 Age ,ethnic background,occupation
 Onset of LMP and its normality,possible conception dates,bleeding
after LMP,medical history,all prior
pregnancies(duration,outcome,and complications),symptoms of
present pregnancy
 Use of drugs, alcohol,tobacco,caffeine,nutritional habits
 Family history of congenital anomalies and heritable disease
 History of childhood varicella
 Prior STDs or risks for HIV infection
 How to describe a woman’s gravidity
para x+y
x is the number of babies delivered (include
live birth, stillbirth)
y is the number of pregnancies the woman
has had(include ectopic pregnancies and
abortions prior to 24 weeks gestation)
孕 2 产 0 孕 38W 待产 (Chinese)
Physical examination
 Height,weight,blood pressure,general physical
examination
 Abdominal and pelvic examination:
1.estimate uterine size or measure fundal height
2.evaluate bony pelvis for symmetry and
adequancy
3.evaluate cervix for structural
anatomy,infection,effacement,dilation
4.detect fetal heart sounds by Doppler device
after 10 weeks
Laboratory tests
■ Urinalysis,complete blood count(RBC
HGB,WBC,PLT),blood group,RH
type,atypical antibody screening,HbsAg
evaluation,ALT,AST,etc.
■ HIV screening,cervical Pap smear
Advice to patients

■ prenatal visits
maintain a schedule of regular
prenatal visits:
0-28weeks every 4 weeks
28-36weeks every 2 weeks
36weeks on weekly
■ Diet
1.eat a balanced diet containing the major food
groups
2.take prenatal vatamins with iron and folic acid
3. expect to gain 10-15Kg. Do not diet to lose
weight during pregnancy
4.decrease caffeine intake to 0-1 cup of coffe
,tea, or cola daily
5.avoid eat raw or rare meat
6.eat fresh fruits and vegetables and wash them
before eating
medication
 Do not take medications
unless prescribed or
authorized by physician
 Abstain from
alcohol,tabacoo,and all
recreational drugs
Common drugs that are
teratogenic or fetotoxic
Alcohol
androgen
Estrogen
misoprostol
ribavirin
Tobacco smoking
progestins
■X –Rays and noxious
exposures
1.Avoid x-rays
2.inform physicians
3. Avoid chemical or radiation
hazards
4. Avoid handling cat and dog
■ Rest and activity
1.obtain adequate rest each day
2.abstain from strenous physical
work or activity
3. exercise regularly
4. Avoid exhausting or hazardous
exercise
■ Birth classes
enroll in a childbirth
preparation class well
before due date
Tests & procedures

Each vist:
weight,blood pressure, fundal
height,fetal heart rate, urine
specimen for protein and glucose,
health ,and nutrition
6-12weeks

Confirm uterine size and


grouth;document fetal heart
tones;chorionic villus
sampling
12-18weeks
 Genetic counseling for women 35 years
or older at EDC
 Those with a family history of
congenital anomalies, a previous child
with chromosomal abnormality,and so
on
 Perform aminocentesis
12-24weeks

 Fetal ultrasound
examination to show
fetal anatomy in
greater detail
16-20weeks

 Maternal serum AFP


testing and HCG to
screen fetal teratogenic
20-24 weeks
 Instructpatient in signs of preterm
labor and rupture of membranes

24-28 weeks
Screening for GDM(gestational
diabete mellitus)by a 50g glucose load
or OGTT
28-36 weeks

 Repeat the complete blood count to


evaluate for anemia of pregnancy
 Determination of fetal position and
presention(LOA or LOP)
 Antepartum fetal testing (NST,OCT)
36 weeks to delivery
 Repeat HIV testing ,cervical culture N
gonorrhoeae and chlamydia in at-risk
patient
 Elective delivery piror to 37 weeks of
gestation should confirmation of fetal
lung maturity
Nutrition in pregnancy

balanced nutrient
weight normal
the healthy mum give birth to a
healthy baby
Combining Forms
Combining Form meaning Terminology Meaning
 amni/o amnion amniocentesis
amniotic fluid
Produced by fetal membranes and the fetus.
 cervic/o cervix,neck endocervicitis
 chori/o chorion choriogenesis
chorion/o chorionic
 colp/o vagina colporrhaphy
colposcopy
 culd/o cul-de-sac culdocentesis
Placement of a needle through the posterior wall of the vagina
with withdrawal of fluid for diagnostic purposes.
Combining Form meaning Terminology Meaning
 men/o menses, amenorrhea

menstruation Absence of menses for 6


months or for longer than 3 of the patient’s normal menstrual
cycles.
dysmenorrhea

oligomenorrhea

Infrequent or scanty menstrual periods.


menorrhagia

Abnormally heavy or long menstrual


periods. Fibroids are a leading causes of menorrhagia.
Combining Form meaning Terminology Meaning
metr/o uterus metrorrhagia
metri/o Uterine bleeding other than caused by
menstruation.
menometrorrhagia

Excessive uterine bleeding at and between menstrual


periods.
endometriosis
 my/o muscle myometrium
 myom/o muscle tumor myomectomy

Removal of fibroids from the uterus.


 nat/i birth neonatal
The first 4 weeks of life after birth.
 obstetr/o midwife obstetric
Combining Form meaning Terminology Meaning
 ov/o egg ovum

 ovari/o ovary ovarian


 salping/o fallopian tubes salpingectomy

 uter/o uterus uterine prolapse

 vagin/o vagina vaginal orifice

Orifice means opening.


Vaginitis

Bacteria and yeast (Candida) commonly


cause this infection.

 vulv/o vulva vulvovaginitis


Suffixes

Suffix Meaning Terminology Meaning


 -arche beginning menarche

 -gravida pregnancy primigravida

A woman during her first


pregnancy (primi-means first). Gravida is
also used as a noun to describe a pregnancy
woman, and it may be followed by numbers
to indicate the number of
pregnancies(gravida 1,2,3)
Suffix Meaning Terminology Meaning
 -parous to bear,bring primiparous

forth An adjective describing a woman who


has borne (delivered )at least one child. Para is also used as a noun
and may be followed by numbers to indicate the number of
deliveries after the 20th week of gestation (para 1,2,3).

 -rrhea discharge leucorrhea


This nonbloody vaginal discharge may be mucoid or purulent
(containing pus) and a sign of infection or cervicitis.
menorrhea

 -tocia labor,birth dystocia


oxytocia
Oxy-means rapid.
Case 1
 Name : Mary Sex:Female
 Age :30 Occupation:Teacher
 She has married for one year,now She has following
problems:cessation of menstruation about 2 months,
Her appitite has declined for three weeks,she goes to
toilet every 2 hours in recent 3 weeks .
Question:
List her probably symptoms and signs .
Make a clinical diagnosis.
Make a clinical differential diagnosis for the
enlargrment of uterus.
Case 2
 Lili’s
menstruation has stopped for 38 weeeks .
She has a girl of 3 years old.this is her second
gestation.Now she feels the normal fetal
movement every day .Through examination ,
her weight is 70 Kg,
Bp 110/70 mmHg,FHR is 142 bpm,the height
of the uterus is 34 cm,the fetal’s occiput is in
the left anterior side of maternal.
Question:
Give the correct diagnosis
wish you :
Learn to learn ;
Learn to do ;
Learn to together ;
Learn to be.

—— 原香港中文大学校长金耀基