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Flashcards in Pregnancy Deck (14):
1

How to diagnosis pregnancy?

- History
- physical signs
- investigations

2

Steps and information in History in pregnancy

- obstetrical and gynecological history
- obtain the year, location, mode of delivery, duration of labour, sex, gestational age, birth weight,
and complications of every pregnancy; organize into GTPAL format
- Gravidity (G)
Š-- G: total number of pregnancies of any gestation (multiple gestation=one pregnancy)
ƒ-- includes current pregnancy, abortions, ectopic pregnancies, and hydatidiform moles ƒ
Parity (TPAL)
Š--T: number of term infants delivered (>37 wk)
--ŠP: number of premature infants delivered (20-36+6 wk)
--ŠA: number of abortions (loss of intrauterine pregnancy prior to viability of fetus <20 wk
and/or <500 g fetal weight)
– induced (therapeutic) and spontaneous (miscarriage)
Š-- L: number of living children
- symptoms: amenorrhea, nausea and/or vomiting, breast tenderness, urinary frequency, and
fatigue

3

What information to obtain to get the history of pregnancy?

obtain the year, location, mode of delivery, duration of labour, sex, gestational age, birth weight,
and complications of every pregnancy; organize into GTPAL format

4

How to organize the history information in pregnancy diagnosis?

GTPAL format

5

What is GTPAL format?

- Gravidity (G)
Š-- G: total number of pregnancies of any gestation (multiple gestation=one pregnancy)
ƒ includes current pregnancy, abortions, ectopic pregnancies, and hydatidiform moles ƒ
- Parity (TPAL)
--- ŠT: number of term infants delivered (>37 wk)
--- ŠP: number of premature infants delivered (20-36+6 wk)
Š--- A: number of abortions (loss of intrauterine pregnancy prior to viability of fetus <20 wk
and/or <500 g fetal weight)
– induced (therapeutic) and spontaneous (miscarriage)
Š---L: number of living children

6

Physical signs in pregnancy diagnosis?

- Goodell’s sign: softening of the cervix (4-6 wk)
- Chadwick’s sign: bluish discolouration of the cervix and vagina due to pelvic vasculature
engorgement (6 wk)
- Hegar’s sign: softening of the cervical isthmus (6-8 wk)
- uterine enlargement
- breast engorgement, areolae darkening, and prominent vascular patterns

7

Goodell’s sign

softening of the cervix (4-6 wk)

8

Chadwick’s sign

bluish discolouration of the cervix and vagina due to pelvic vasculature
engorgement (6 wk)

9

Hegar’s sign

softening of the cervical isthmus (6-8 wk)

10

Investigations in pregnancy diagnosis

- β-hCG:
- U/S

11

β-hCG:

- peptide hormone composed of α and β subunits produced by placental trophoblastic cells – maintains the corpus luteum during pregnancy
ƒ positive in serum 9 d post-conception,
--- positive in urine 28 d a er rst day of LMP
ƒ--- plasma levels double every 1-2 d, peak at 8-10 wk, then fall to a plateau until delivery
------ Šlevels less than expected suggest: ectopic pregnancy, abortion, or inaccurate dates
Š------- levels greater than expected suggest: multiple gestation, molar pregnancy, Trisomy 21, or inaccurate dates

12

U/S

- transvaginal
- transabdominal

13

transvaginal

- Š5 wk amenorrhea: gestational sac visible Š
- 6 wk: fetal pole visible
- Š7-8 wk: fetal heart activity visible

14

transabdominal

6-8 wk: intrauterine pregnancy visible (β-hCG ≥6,500 mIU/mL)