DIAGNOSIS OF

PREGNANCY
History
Physical examination
Investigations
Differential diagnosis
 HISTORY
AMENORRHOEA – stress/emotional upset, lactation, contraceptive
pill, hormonal (ovarian-pituitary) imbalance
BREAST CHANGES – Increase in size, heaviness/pain in the
breasts
FREQUENCY OF MICTURITION – initially due to increased
vascularity & pressure from the enlarging uterus but later due to
pressure from the fetal head on the bladder.
MORNING SICKNESS – gastric upset ranging from anorexia to
nausea and repeated vomiting especially in the morning (usually
from the 6th to 14th Wk). Attributed to hCG levels due to higher
incidence in multiple pregnancy/molar pregnancies. Severe form
→hyperemesis gravidarum
PTYALISM
ABDOMINAL ENLARGEMENT – may initially be due to slight
intestinal distension before the uterine enlargement becomes
evident. Consider 5F’s.
QUICKENING – Fetal movement may be slight initially and
confused with wind in the intestine. It is first noticed at about the 16th
Wk for multipara & 18th – 20th Wk for primigravida. In pseudocyesis,
the patient convinces herself of its’ presence.
 PHYSICAL EXAMINATION
SKIN CHANGES – pigmentation of the face & areola (10 & 20) of the
breasts; Montgomery’s tubercles (prominent sebaceous glands
as pink red nodules on the areola)
PROGRESSIVE ENLARGEMENT OF THE UTERUS
PAINLESS UTERINE CONTRACTIONS (can be felt even in a pelvic
uterus with a co-operative patient)
BALLOTTEMENT – internal (14 Wks) & external (24Wks)
Palpation of FETAL PARTS(24-26Wks) & FETAL MOVEMENT
(20Wks)
FETAL HEART SOUNDS (24th Wk), uterine soufflé (20th Wk) & funic
soufflé (umbilical cord blood flow)
JACQUEMIERS SIGN – darkening of vaginal skin (8Wks)
HEGARS SIGN – softening of the lowest part of the body of the
uterus (8 Wks)
OSIANDERS SIGN – increased pulsation in the lateral fornices
(8Wks)
SOFTENING & BLUE DISCOLORATION OF THE CERVIX
(complete by the 16th Wk)
 INVESTIGATIONS
Tests on maternal urine –
immunochemical tests
Tests on maternal plasma/serum –
radioimmunoassays & enzyme-linked
immunosorbent assays (ELISA)
Ultrasonography – Abdominal & trans-
vaginal, sonicaid (10Wks)
Abdominal X-rays
DIFFERENTIAL DIAGNOSIS
Uterine fibroids
Ovarian cysts
Distended bladder
Pregnancy associated with uterine
fibroids/ovarian cysts
Pseudocyesis