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Lecturer Liu Wenhui

Sophie liu

The Department of Gynecology &Obstetrics in Zhongnan Hospital

Diagnosis of early Pregnancy

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Contents

Intruction

Manifestions of early pregnancy

Helpful examinations of early pregnancy

Differential diagnosis of early pregnancy

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ObjectivesMaster the Definition of pregnancy

Master the Manifestions of early

pregnancy

Master pregnancy test and other helpful

examinations especially ultrasonography

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Case

Name : Mary Sex:Female

Age :30 Occupation:Teacher

She has married for one year,now She has

following symptoms:cessation ofmenstruation,nausea and vomiting,urinaryfrequency and urgency;

She has following signs: enlargement of

uterus,softening of the cervix, softening of thecervicouterine junction

Which problem has she ?How can you helpher?

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Introduction

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Sexual reproduction is

the union of the nucleiof the female sex cell

(ovum) and the male

sex cell (sperm cell)

that results in thecreation of a new

individual

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PregnancyDefinition:

Growth and developmental process in a

women from fertilization through

embryonic and fetal period to

birth;gestation orconception

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Sexual reproduction is

the union of the nucleiof the female sex cell

(ovum) and the male

sex cell (sperm cell)

that results in thecreation of a new

individual

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From now on

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27

Early

pregnancy

The second

trimester

The third

trimester

12

(LMP)

(EDC)

4040280280,,

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How to Diagnose the early Pregnancy ?

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Manifestations of

early Pregnancy

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Amenorrhea :no menstruation flow or

cessation of menstruation (The cyclicalloss of sanguineous fluid from the uterus in

mature women. The usually duration of themenstrual cycle is 3-5 days. The average

amount of blood lost is 30-80ml)

10 days or more after the time ofexpected onset of the menstrual period

A.Symputoms

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Nausea with or withoutvomiting(morning sickness)

Nausea is an unpleasant

sensation in the stomach anda tendency to vomit

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hCG

day 7

2-cell stage

Morula

Blastocyst

Implanting

blastocyst

Endometrium

Urinary frequency and urgency

Begins about 6th week ,anddisappears about 12th week

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The breast: Accessary Organ of Reproduction2nd development ,1st is in adolesence

Pain slightly

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B.Signs

Breast changes(enlargement,MontgomeryMontgomery)

HegarHegarssign:ssign:

softening of thecervix, softening of

the cervicouterinejunction (Bimanualpalpation)

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otherExaminations

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Clinical testPregnancy test

hCG

day 7

2-cell stage

Morula

Blastocyst

Implanting

blastocyst

Endometrium

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Be detected in

plasma or urine by

8-9 days afterovulation

H

CG

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Blood or urine test todetect the presenceofH G

Get a peak at about8 to 10 weeks

Then declines slowlyand maintains lowlevel at about 100 to

130 days untildelivery

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StepsSteps ::

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7wk Embryo and Yolk Sac

5wk Embryo and Yolk Sac

Pelvic ultrasonography

A.35day all sac visible

B.42day all heart beat

detectable

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Asmall increase in body temperature during the lutealAsmall increase in body temperature during the luteal

phase of the menstrual cycle last over 3 weeksphase of the menstrual cycle last over 3 weeks

Basal body temperatureBasal body temperatureBBTBBT

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Pregestin testUse of pregestin 20mg every day for

three or five days

Withdrawal of pregestin

Within 7 days may bleeding or not

(pregnant)

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Cervical mucus examination

steps

elluar appearance

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Celluar appearance Palm leaf pattern

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Differential diagnosis ofpregnancy

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M

yomas(fibroids)Belign tumor in theuterus

hanges of

menstruationVery firm and irregular(Bimanual palpation)

Pregnancy test isnegative

No embyro in theuterine cavity

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Ovarian tumor

Pregnancy test is negative

No embyro in the uterine cavity

Found midline ,displacing the

nonpregnant uterus to the side or

posteriorly

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1.Pregnancy test is positive

2.No embyro in the uterine cavity

!!:90%of ectopic pregnancy occur in the fallopiantubes(tubal pregnancy),rupture of the ectopic pregnancywithin the fallopian tube can lead to massive

hematosapinx.

Surgeons remove the implant andpreserve the fallopian tube before

rupture occurs.

Laproscopy

Ectopic pregnancy

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Questions ?

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T

rue or false

If a women fells nausea andvomitong ,she is pregnant .

A pregnant womens LMP is 12/9-2007,her ED is 7/9-2008.

HcG levels double approxiamately

every 72 houys in early pregnancy.The uterus is enlarged ,the women ispregnant.

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Which manifestions are there in early

pregnancy?

Which examinations are helpful to

diagnose early pregnancy?

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Early pregnancy

The second trimester and the

third trimester

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