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Calculated from first day of last menstrual period Called as menstrual age / GAFertilization age – 266 daysOvulation – 266 days
Subjective Symptoms Amenorrhoea Missing of period Morning sickness Present in 50% of casesNausea / Vomiting / Loss of appetite
Frequency of urine Pressure of enlarged uterus on bladderCongestion of bladder mucosa Breast discomfort / Giddiness / Fatigue
PA - Uterus not palpable Jaequemier’s sign / Chadwick's signBluish colouration of vagina – local vascular
congestion Nonirritating mucoid discharge vascularity
Goodell’s sign Cx softened - vascularity Uterus enlarged, soft , elastic Hegar’s sign Softened interned os
Immunological tests for diagnosis of pregPrinciple Detection of hCG antigen in maternal urine &
serum Various kits available
Gravindex test – slide test Put one drop of urine on the slide If one line present - not pregnantIf two lines present - pregnant
Selection of time 8 to 11 days after conception i:e within a wk after missing of periodNot reliable after 12 wks
Uses of preg testsTo confirm intra uterine pregnancyTo diagnose ectopic pregnancyTo monitor or follow up molar pregnancy &
chorio carcinoma
Test accuracy 98.6 to 99%Non preg level – 1 mIU / mlLimitations – Accuracy affected, due toHaemoglobin, Albumin, LH, Immunological
diseases
USGIntra uterine gest sac + Yolk sac - 5th wkFoetal pole, cardiac activity – 6 wksEmbryonic movements – 7 wksGA – 7 & 12 wks
Signs Chloasma – pigmentation over forehead
– checks – 24 wksBreasts – enlarged with prominent veins
Secondary areola – 20 wksMontgomery tubercles over secondary areola Colostrum – thick & yellowish – 16 wksLinear pigmented line – linea nigra & striae - 20 wks
Fundal height – increased progressively Just palpable – 14 wksBetween symphisis & umbilicus – 16 wksAt umbilicus – 24 wks
Fetal Heart SoundsAuscultation of FHS – 18 to 20 wks120 – 160 beats per min / over – 140Uterine soufflé Systolic murmur synchronous with maternal
pulse due increased blood flow through dilated uterine vessels
Funic or foetal soufflé Rush of blood through umbilical arteries –
soft, blowing murmur synchronous with foetal heart sounds
Investigations Sonography – 18 to 20 wksdetailed exam for foetal anatomy, placental
localization, integrity of Cx canal
Foetal movements / FH Sounds present Foetal parts FHS not heard – IUD / obesity / polyhydramniosSonography
Differential diagnosis Abdomino pelvic massDistended bladderUterine fibroid Cystic ovarian tumour Encysted tubercular peritonitis Haematometra