Diagnosis In Pregnancy

All

Ans. is a and c i.e. Braxton hicks contraction; and Quickening

Second trimester of pregnancy (13-28 weeks) can be diagnosed by :

Symptoms :

• Quickening • Perception of active fetal movements felt by 18 weeks of pregnancy in pnrnipara and 2 weeks earlier in multiparae
• Progressive enlargement : Of the lower abdomen by the growing uterus.

Ans. b is 16-20 wks

“Quickening (feeling of life) denotes the perception of active fetal movements by the women. It is usually felt about the 18^th week°, 2 weeks earlier in multiparae. Its appearance is an useful guide to calculate the expected date of delivery with reasonable accuracy”

“Quickening is felt b/w 16” to 2G week^c“-Reddy 

Phenomenon                                                                   me

• 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
• Fl-IS audible by Stethoscope                18-20 weeks
• Lightening                                                38 weeks

Cullen’s sign

Hegar’s sign

Pulsation in the lateral vaginal fornix

Bluish discoloration of vagina

Amenorrhoea

Fetal heart sound

Excessive salivation 

Occur during most of the months of pregnancy

Lactobacillus acidophilus is increased in pregnancy.

Ref: Textbook of Obstetrics By Dutta, 6th Edition, Page 47 ; Williams Gynaecology, 2nd Edition, Page 172

The breast becomes fully differentiated during pregnancy and lactation.

The terminal lobular units are most affected during this physiologic state.

Several histologic changes occur in the terminal ducts and lobules with enlargement and formation of new lobular units early in pregnancy.

By the end of the second trimester secretory changes are well developed and the cuboidal luminal epithelial cells show evidence of vacuolization.

Accumulation of fat droplets occurs within the cytoplasm of the epithelium of the lobules during the third trimester.

The lobules undergo striking hyperplasia to occupy most of the breast parenchyma during this time, with a decrease in the interlobular connective tissue.

At term the expanded lobular units show marked distention of their lumina by colostrum.

During pregnancy, the myometrium goes through a period of extensive growth involving both hyperplasia (increasing the number of smooth muscle cells), cell hypertrophy, and increased collagen production by the muscle cells, which strengthens the uterine wall.

This well-developed uterine myometrium contracts very forcefully during parturition to expel the infant from the uterus.

After pregnancy, uterine smooth muscle cells shrink and many undergo apoptosis, with removal of unneeded collagen, and the uterus returns almost to its prepregnancy size.

Ref: Mescher A.L. (2013). Chapter 22. The Female Reproductive System. In A.L. Mescher (Ed), Junqueira’s Basic Histology, 13e.

Palmer’s sign refers to the regular and rythmic uterine contractions which is elicited during bimanual examination.

It is present as early as 4-8 weeks.

• Osiander’s sign refers to the feeling of increased vaginal pulsation felt through the lateral fornices at 8th week of gestation.
• Jacquemier’s sign or Chadwick’s sign refers to the dusky hue of the vestibule and anterior vaginal wall visible at about 8th week of pregnancy.
• Goodell’s sign refers to softening of the cervix as early as 6th week of gestation.

Jacquemier’s or chadwick’s sign: It is the husky hue of the vestibule and anterior vaginal wall visible at about 8th week of pregnancy due to local vascular congestion and as such it may be brought about by pelvic tumour such as uterine fibroid.

• Chadwick’s sign: It refers to bluish discoloration of cervix caused by congestion of pelvic vasculature. It is a presumptive sign of pregnancy.
• Jacquemier’s sign: It refers to congested appearance of vaginal mucosa.
• Osiander’s sign: It refers to increased pulsations felt in the lateral fornices at 8 weeks of gestation.
• Goodell’s sign: It refers to softening of the cervix.
• Palmer’s sign: refers to intermittent contractions of the uterus.

• Palpation of fetal parts and perception of active fetal movements
• Ultrasonographic evidence of gestational sac and embryo in early pregnancy and later.

• Change in size, shape and consistency of uterus
• Softening of cervix
• Osiander’s sign, Chadwick’s sign, Goodell sign
• Abdominal enlargement
• Braxton Hicks contraction
• External and internal ballottement

Ans. C i.e. Feeling of first foetal movement by mother

Ans. D i.e. All are same

• MC type: Gynaecoid
• Platypelloid/ flat pelvis: Transverse diameter is more than AP diameter
• Least common type of pelvis: Platypelloid
• Deep transverse arrest/ persistent occipito posterior position is common in: Android pelvis
• AP diameter more than transverse diameter: Anthropoid pelvis
• Face to pubis delivery is common in: Anthropoid pelvis
• Shortest diameter of pelvic inlet: Obstetric conjugate

Ans. B: 4- 6

Vaginal secretion becomes copious, thin and curdy white, due to marked exfoliated cells and bacteria. The pH becomes acidic (3.5-6) due to more conversion of glycogen into lactic acid by the lactobacillus.

Ans. C: 24 weeks

The height of the uterus is midway between symphysis pubis and umbilicus at 16th week; at the level of umbilicus at 24^th week and at the junction of the lower third and upper two-third of the distance between the umbilicus and ensiform cartilage at 28^th week.

Ans. B: 2 days

Pregnancy tests may be used to determine the viability of a pregnancy.

Serial quantitative blood tests may be done, usually 2-3 days apart.

Below an hCG level of 1,200 mIU/ ml the hCG usually doubles every 48-72 hours, though a rise of 50-60% is still considered normal.

Failure to increase normally may indicate an increased risk of miscarriage or a possible ectopic pregnancy.