PRENATAL CARE

WILLIAM OBSTETRICS
Page 205-208
By :Rusiyanti

Diagnosis of Pregnancy :
Signs and Symptomps : - Discoloration of
the vaginal
mucosa
- Skin changes
- Changes in the uterus
- Changes in the cervix
- Fetal heart action
- Chorionic gonadotropin
Initial Prenatal Evaluation

DIAGNOSIS OF
PREGNANCY
SIGNS AND SYMPTOMPS

Discoloration of the vaginal

mucosa
Appears dark bluish or purplish
red and
congested

Chadwick Sign

Presumptive evidence of
pregnancy, but its
not conclusive

Skin
Changes
Increased pigmentation and changes in
appearance of
abdominal striae
May be absent during pregnancy
May be seen in women taking estrogenprogestin
contraceptives

Changes in the Uterus

First few weeks of pregnancy increase in
uterine siza is limited principally the
anteroposterior diameter
12 weeks :
The body of the uterus is almost globular and an
average uterine diameter of 8cm is attained
On bimanual examination : feels doughy or elastic
and sometimes becomes exceedingly soft
At about 6 to 8 weeks menstrual age :
On bimanual examination a firm cervix is felt which
contrasts the now softer body of the uterus and
compressible interposed softened istmus

Hegar Sign

Changes
in the
Cervix
Undergoes increased
softening
as
pregnancy advances.
In primigravidas
the consistency of
the cervical tissue that surrounds the
external os is more similar to that of the lips
of the mouth than to that of nasal cartilage
characteristic of the nonpregnant cervix.
As pregnancy progresses
the cervical
canal may become sufficiently patulous to
admit the fingertip.

Estrogen-progestin contraceptives
may cause cervical softening.

Fetal Heart Action

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
110 - 160 beats/min
Heard as a double sound resembling the tick of a
watch under a pillow.
Fetus moves freely in amnionic fluid
the site
on the maternal abdomen where fetal heart sounds
can be heard best will vary.
Doppler ultrasound
Vaginal sonography

10 weeks
as little as 5 weeks

of
amenorrhea.

of pregnancy :
1. The funic (umbilical cord) "souffle."
. The rush of blood through the umbilical arteries
. A sharp, whistling sound that synchronous with the fetal
pulse
. Not heard consistently, even in the same pregnancy.
2.
The uterine "souffle.
.
Soft,blowing sound that is synchronous with the maternal
pulse
.
Usually heard most distinctly near the lower portion of
the uterus
.
Produced by the passage of blood through the dilated
uterine
vessels
.
May be heard with any condition in which uterine blood
flow is
greatly increased (example : with large uterine myomas
or ovarian
tumors)
3.
Sounds resulting from fetal movement.
4.
Maternal pulse
.
Can be heard distinctly by auscultation of the abdomen
.
In some women, the pulsation of the aorta is unusually
loud.
.
Occasionally the pulse of the mother may become so

PERCEPTION OF FETAL MOVEMENTS.

can begin to detect At or about 20 weeks

Chorionic Gonadotropin
Detection in maternal blood and urine (sensitive test :
8 to 9 days after ovulation)
A glycoprotein with a high carbohydrate content
Heterodimer composed of two dissimilar subunits,
designated and which are noncovalently linked
The -subunit is similar to those of LH, FSH, and TSH
Prevents involution of the corpus luteum, the principal
site of progesterone formation during the first 6 weeks.
Trophoblast cells produce hCG in amounts that
increase exponentially following implantation.
The doubling time : 1.4 to 2.0 days
Increase from the day of implantation, reach peak
levels : 60 to 70 days.
Declines slowly until a nadir is reached at about 14 to
16 weeks

MEASUREMENT OF hCG.

LH and hCG were both composed of an - and a subunit

structurally distinct antibodies were developed with high
specificity for the subunit of hCG
the basis for detection of hCG in urine or blood.
Sandwich-type immunoassay
uses a monoclonal antibody
against the subunit bound to a solid-phase support exposed
to hCG in the serum or urine specimen second antibody is then
added to "sandwich" the bound Hcg the sensitivity : as low as 1.0
mIU/mL
False-positive rare
Some women have circulating factors in their serum that may
interact with the hCG antibody. The most common are heterophilic
antibodies, which are human antibodies directed against animalderived antigens used in immunoassays.

HOME PREGNANCY TESTS.

Cole and colleagues (2004) found that a detection limit of

12.5 mIU/mL would be required to diagnose 95 percent of
pregnancies at the time of missed menses. In their study
of the accuracy of 18 different home pregnancy tests, they
also found that only one brand had this degree of
sensitivity. Two other brands gave false-positive or invalid
results. In fact, clearly positive results were given by only
44 percent of the brands at an hCG concentration of 100
mIU/mL.
A test capable of detecting this level would be expected
to identify only about 15 percent of pregnancies at the
time of the missed menses.

Ultrasonic Recognition of
Pregnancy.

The use of transvaginal sonography has

revolutionized imaging of early pregnancy and
its growth and development.
A gestational sac may be demonstrated by
abdominal sonography after only 4 to 5 weeks
menstrual age
By 35 days, all normal sacs should be visible,
and after 6 weeks, a heartbeat should be
detectable.
Up to 12 weeks, the crown-rump length is
predictive of gestational age within 4 days.

Initial Prenatal Evaluation

The major goals are:
1. To define the health status of the
mother and
fetus.
2. To estimate the gestational age of
the fetus.
3. To initiate a plan for continuing
obstetrical care.

Typical Components of Routine

Prenatal Care

A Performed at 28 weeks, if indicated.

B Test should be offered.
C High-risk women should be retested at the beginning
of the third trimester.
D High-risk women should be screened at the first
prenatal visit and again in the third trimester.

TERIMA KASIH