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Signs of Pregnancy

The mean duration of pregnancy is calculated from the first day of the last normal menstrual period and is 280 days or 40 weeks or 9 months and 7 days (Naegele's rule).
 

Name

Gestation

Description

Jacquemier's or Chadwick's sign

8th week

Dusky hue of the vestibule and anterior vaginal wall due

to local vascular congestion

 

 

Osiander's sign

8th week

Increased pulsations felt through the lateral fornices; also

felt in acute PID

 

 

Goodell's sign

6th week

Softening of the cervix

Piskacek's sign

6-8 weeks

There is asymmetrical enlargement of the uterus if there is

lateral implantation

 

 

Hegar's sign

6-10 weeks

On bimanual examination, the abdominal and vaginal

fingers appose each other

 

 

Palmer's sign

4-8 weeks

Regular and rhythmic contractions during bimanual

examination

 

 

 

Extra Edge:

  1. In the first trimester uterus enlarges to the size of hens egg at 6th week, cricket ball size at 8th week and size of fetal head by 12th week. It remains an intrapelvic organ.
  2. Other signs seen in early pregnancy:
  3. Ladin's sign: At 6 weeks, the uterus softens in anterior midline along the utero cervical junction.
  4. Mc Donald sign: The uterus becomes flexible at uterocervical junction at 7 - 8 weeks.
  5. Von Fernwald sign: Softening of fundus at 4 - 5 weeks.

Sign

Feature

Seen at

Chloasma

Breast changes

Pigmentation over forehead & cheeks

Appearance of secondary areola

Secretion of colostrum

Thickening of colostrum

12 weeks of pregnancy

 

- Size

Increases with increasing gestational age & uterus feels soft & elastic. Uterus becomes an abdominal organ

 

- Braxton hick contractions

irregular, infrequent spasmodic & painless contractions without any effect on dilatation of the cervix.( Intrauterine pressure is <8 mm of Hg)

Begin in early pregnancy & continue till term

 

Palpation of fetal parts & active fetal movement

They are positive signs of pregnancy

Elicited by 20 weeks

Ballottement of uterus

Ballottement of uterus on bimanual examination gives the impression of a floating object inside the uterus. It may also be seen in case of uterine fibroid, ascites or ovarian cyst

Elicited between 16 - 200 weeks of pregnancy

Auscultation of fetal heart sound

Most conclusive sign of pregnancy

Heard by stethoscope between 18-20 weeks of pregnancy

Fetal cardiac motion can be detected by Doppler by 10 weeks

 

Note: Lightening - is a sense of relief from the pressure symptoms due to engagement of the presenting part. lt is felt at 38th week in primigravida i.e. it is seen in 3rd trimester. Show is a sign of labour.

 

NOTE:

  1. The fetal kidneys start producing urine at 12 weeks.
  2. By the end of the 12th week of pregnancy, when the uterus usually is just palpable above the symphysis pubis, the crown-rump length of the fetus is 6-7 cm. The fetus begins to make spontaneous movements.
  3. By the end of the 16th week, the crown-rump length of the fetus is 12 cm, and the weight is 110 g. Gender can be correctly determined by inspection of external genitalia by 14 weeks.
  4. By the end of the 24th week, the fetus weighs about 630 g.
  5. By the end of the 28th week, a crown-rump length of about 25 cm is attained and the fetus weighs about 1100 g.
  6. At the end of 32 gestational weeks, the fetus has attained a crown-rump length of about 28 cm and a weight of about 1800 g.
  7. The fetal heartbeat can be detected by auscultation with a standard nonamplified stethoscope by a mean of 17 weeks and by 19 weeks in nearly all pregnancies in nonobese women. Fetal cardiac action can be detected at 10 weeks with Doppler equipment.

Positive or absolute signs of pregnancy

  1. Palpation of fetal parts and perception of fetal movements by examiner, at about 20 weeks.
  2. Auscultation of fetal heart sounds.
  3. USG evidence of embryo ( at 6th week) and later on of the fetus.
  4. Radiological demonstration of fetal skeleton at 16 weeks and onwards.

Weight gain in pregnancy

 

Weight-for-Height

Recommended Total Weight Gain (kg)

Category

BMI

Low

<19.8

12.5-18

Normal

19.8-26

11.5-14

High

26-29

7-11.5

Obese

>29

7

 

Distribution of weight

 

Reproductive weight gain: 6 kg

Net maternal weight gain: 6 kg

• Fetus 3.3 kg

• Increase in blood volume 1.3 kg

• Liquor O.S kg

• Increase in extracellular fluid 12 kg

• Placenta 0.6 kg

• Accumulation of fat and protein 3.5 kg

• Uterus 0.9 kg; breasts 0.4 kg

 

 

Usg in Early Pregnancy

 

 

Transvaginal sonography (TVS)

Transabdominal sonography (TAS)

Gestational sac

4 weeks 5 days

5 weeks 5 days

Yolk sac

5 weeks

6 weeks

Fetal pole

6 weeks

7 weeks

Fetal cardiac activity

6 weeks

7 weeks


Critical titer of hCG to visualize the gestational sac within the uterus:

 

TVS = 1000 micro IU / mL

 

TAS = 3500-6000 micro IU/mL
 

Menstrual age (weeks)

Fetal Structures

4

Choriodecidual thickness, chorionic sac

5

Gestation sac, embryo yolk sac

6

Fetal pole, cardiac activity

7

Lower limb buds, midgut herniation (physiological)

8

Upper limb buds, stomach

9

Spine. Choroid plexus

 

Best parameters for estimation of fetal age

 

1st trimester: Crown Rump length (CRL)

 

2nd trimester: Corrected biparietal diameter (cBPD) or head circumference (HC)

 

3rd trimester: Head circumference and femur length

 

Overall: Crown rump length

 

Extra Edge: USG in Pregnancy

  1. Best time to assess gestational age by USG is 9 – 12 weeks (by crown rump length).Q
  2. Best indicator of fetal growth - Abdominal circumferences
  3. So the best USG parameter to detect IUGR is Abdominal circumference.
  4. The best USG parameter to detect Macrosomia is Abdominal circumference
  5. Transcerebellar diameter (TCD) is an accurate predictor of gestationa age when measured between 14 and 28 weeks.
  6. Fetal anomaly which can be earliest detected by USG- Anencephaly.
  7. Lemon and Banan sign are seen in spina bifid a on USG,
  8. The two best ultrasonographic markers of Down syndrome in first trimester-
    1. Absent or hypoplastic nasal bone
    2. Increased nuchal translucency
  9. The diameter which in mm when measured between 14 and 24 weeks corresponds to the gestational age in weeks - Inter cerebellar diameter.
  10. CRL (in mm) + 42 = gestation in days.
  11. Also mean sac diameter (MSD) in mm + 30 = GA in days
  12. The embryo should increase its CRL by 1 mm per day. Failure to visualize an embryo when the MSD is 6 mm, indicates pregnancy loss.

Signs of pregnancy in 2nd and 3rd trimester

 

Phenomenon

Time

Palpation of fetal part

20 weeks

Active fetal movement felt by placing a hand on abdomen

20 weeks

External ballotment

20 weeks

Internal ballotment

16-28 weeks

FHS audible by Stethoscope

18-20 weeks

Fetal movement can be detected by Doppler

10 weeks

Lightening

38 weeks

ANC Visits

Ideally the schedule for antenatal visits should be:

  1. Monthly visits upto 28 weeks.
  2. Two weekly visit between 28 and 36 weeks.
  3. Weekly visit from 36 weeks onwards

This means a total of 12-15 visits.

 

WHO recommends at least 4 visits:

 

1st at - 16 weeks

 

2nd at - 24-28 weeks

 

3rd at - 32 weeks

 

4th at - 36 weeks
 

As per Indian scenario - minimum 3 visits are essential;

 

1st at - 20 weeks (or as soon as pregnancy is known)

 

2nd - 32 weeks

 

3rd - 36 weeks

  1. The first visit that a woman makes to a health care facility is called the booking visit.
  2. A booked case is one that has at least 3 aantenatal visits with at least two in the last trimester.

Kegels exercises - Time for initiating kegels exercise:

  1. Pregnancy-1 st trimester
  2. After vaginal delivery-after 24 hrs
  3. After cesarean section-after 24 hrs.

Thus in version 1 answer to the question is 24 hrs after delivery and in version 2 answer since we donot have 1 st trimester in option it would be 3rd trimester of pregnancy





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