Pregnancy

Question 1

How to diagnosis pregnancy?

Answer 1

• History
• physical signs
• investigations

Question 2

Steps and information in History in pregnancy

Answer 2

• 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

Question 3

What information to obtain to get the history of pregnancy?

Answer 3

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

Question 4

How to organize the history information in pregnancy diagnosis?

Answer 4

GTPAL format

Question 5

What is GTPAL format?

Answer 5

• 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

Question 6

Physical signs in pregnancy diagnosis?

Answer 6

• 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

Question 7

Goodell’s sign

Answer 7

softening of the cervix (4-6 wk)

Question 8

Chadwick’s sign

Answer 8

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

Question 9

Hegar’s sign

Answer 9

softening of the cervical isthmus (6-8 wk)

Question 10

Investigations in pregnancy diagnosis

Answer 10

• β-hCG:

- U/S

Question 11

β-hCG:

Answer 11

• 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

Question 12

U/S

Answer 12

• transvaginal

- transabdominal

Question 13

transvaginal

Answer 13

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

Question 14

transabdominal

Answer 14

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