1) Diagnosis of Pregnancy - Early, Late; Modern Methods

Question 1

Definition of “Pregnancy”

Answer 1

• Physiological process in a female
• begins with fertilisation of the ovum
• followed by implantation into the uterine
  wall

Question 2

Duration of Pregnancy

Answer 2

40 Weeks, aka 280 Days

Question 3

Stages / Phases of Pregnancy

Answer 3

1) Early = Upto 12 Weeks

2) Mid = 13 - 27 Weeks

3) Late = AFTER 28 Weeks

4) TERM = 37 - 42 Weeks

Question 4

What are the TRIMESTERS?

Answer 4

• 1st Trimester = Upto 12 Weeks
• 2nd Trimester = 13 - 28 Weeks
• 3rd Trimester = 29 - 40 Weeks

Question 5

Explain DUE DATE

Answer 5

• Using NAEGELE’S RULE = 1st Day (Last Period Cycle) + 7 Days + 1 Year - 3 Months
• Affected IF - irregular cycle, or conceived whilst on the pill

Question 6

How is EARLY Pregnancy Diagnosed?

Answer 6

• Performed in 1st TRIMESTER
• History & Sx = Amenorrhea, N/V, Breast enlargement + tenderness, Increased Urinary f
• Objective Sx = GOODELL, HEGAR, LADIN, CHADWICK, PALMERS Signs
• Immunological Testing = hCG (maintains corpus luteum during 8-10 weeks); detected 14 days POST-fertilisation; Peaks at 2-3 Months
• Ultrasound (Trans-V + Abdominal) = Detects Ges-Sac at 5 Weeks, Foetal Pole at 6-7 Weeks, Foetal HR (Doppler) at 10-12 Weeks; True + Pseudo Sacs

Question 7

What are the Objective Signs?

Answer 7

1) GOODELL = Cervical Softening

2) HEGAR = Softening of LOWER Segment of Uterus

3) LADIN = Softening of MIDLINE of Uterus

4) CHADWICK = BLUISH Discolouration of Vagina, Cervix + Labia due to OESTROGEN

5) PALMERS = Regular RHYTHMIC Uterine Contractions upon Bimanual Exam at 4-8 Weeks

Question 8

What are the Tests for hCG (Immunological)?

Answer 8

• ALPHA = For hCG, FSH, LH and TSH
• BETA = Specific to Placenta

Question 9

What’s the DIFFERENCE between TRUE & PSEUDO Sacs?

Answer 9

TRUE

• NOT in the Middle
• Round and Regular
• DOUBLE RING Sign
• YOLK SAC + FOETAL POLE
• Sac Size increases by 1mm / day

PSEUDO

• CENTRALLY Located
• Irregular

Question 10

How is LATE Pregnancy Diagnosed?

Answer 10

• Performed in 2nd / 3rd TRIMESTER
• Sx = Amenorrhea, Enlarged Abdomen, INCREASED Pigmentation of Skin / Striae, Braxton Hicks Contractions, Palpation of Foetal Parts + Fundal Height
• Abdominal Exam = Inspection of Stretch Marks, Palpation (Leopold’s Manoeuvre + Fundal Height), Auscultation
• Ultrasound = N.O of Foetus, the anatomy, Amniotic Fluid VOL, Cervical Canal

1) GOODELL = Cervical Softening

4) CHADWICK = BLUISH Discolouration of Vagina, Cervix + Labia due to OESTROGEN

Question 11

Explain Leopold’s Manoeuvre

Answer 11

1) Bimanual Exam of Foetal Lie - Whether it’s longitudinal, transverse, oblique

2) Locate the Back of Foetus

3) Foetal Presentation - One hand ON Pubic Symphysis to see presenting part is engaged, hard + round so its CEPHALIC

4) Palpation to check FOETAL BROWN + FLEXION DEGREE of Head

Question 12

How is Fundal Height assessed?

Answer 12

• Length from TOP of UTERUS —- TOP of Pubic SYMPHYSIS
• Check Foetal Growth / Development around 20 Weeks

NB! GROWS 1cm per Week, AFTER 20 Weeks