Lectures on pregnancy diagnosis

2021-03-21 12:00 AM

Pregnancy: A woman's change caused by her pregnancy. Choking is manifested: nausea, vomiting, salivation, changes in smell, taste, urology, nerves and psychology.

Outline

Definition of the period of pregnancy

When there is conception and implantation of the egg, a woman's body undergoes physiological changes. These are changes in the appearance of the outside as well as the organs and fluids in the body. All of these changes can cause the symptoms that people call symptoms of pregnancy.

Gestational period is 280 days (40 weeks) from the first day of the last menstrual period.

Clinically we divide the gestation period into two phases

First 4 and a half months: Diagnosis is difficult because the signs of pregnancy are the result of bodily changes caused by pregnancy, that is, the physiological changes of the mother are not immediate signs. continued pregnancy induced.

Period of 4 and a half months: Diagnosis is usually easy because of the obvious symptoms, at this time, the direct signs of the fetus when clearly shown in the clinic such as: fetal movement, hearing the fetal heartbeat, Especially palpable parts of the fetus.

Diagnosis of pregnancy needs to be based on physical as well as physical clinical symptoms, in which physical signs play a decisive role. In addition, in the first months, to diagnose pregnancy, it is necessary to supplement some special subclinical investigations (when differential diagnosis is required).

Diagnosis of pregnancy in the first 4 and a half months of pregnancy

Mechanical symptoms

Amenorrhea: This is a reliable sign to diagnose, but only for healthy women, menstruation has been regular.

Pregnancy: A woman's change caused by her pregnancy. Choking is manifested: nausea, vomiting, salivation, changes in smell, taste, urology, nerves and psychology.

Morning nausea or vomiting, pale mouth, faintness of voice.

Increased salivation should often spit

Fear of some odors that were not previously feared: possibly fragrant, tobacco smell.

Poor appetite or likes to eat other foods (sour, spicy, sweet ...) is called bad food

Pee many times, urinary retention.

Easily irritated, agitated, irritable, or afraid.

Drowsiness, drowsiness, sleep a lot, sometimes insomnia

Discomfort, fatigue, dizziness, memory loss.

These symptoms usually occur after 12-14 weeks of loss.

Physical symptoms

Breast: Rapid enlargement, areola and nipples darkened, Montgomery seeds are prominent, venous growth, colostrum may be present.

Body temperature: usually above 37 ° C.

Skin: Appears pigmentation on the skin, face, abdomen, stretch marks, brown sugar on the abdomen, it is often said that the face is pregnant.

Abdomen: The lower abdomen enlarges after 14 weeks.

Genital apparatus:

Vagina: Darker than normal pink.

Cervix: Purple again, soft density, unchanged size, less secretion, thickening forming cervical mucus node.

Uterine waist: Hégar sign: indicates soft uterine waist

How to determine (the uterus reclines, the hands in the vagina put in the front pocket, the uterus back, the hands in the vagina put into the last pocket, combined with the two fingertips stretched through the abdominal wall, feeling like death the uterus and cervix separate and form two separate masses.

Signs of Hégar should not be done because it can easily cause miscarriage. (Artwork of the Hégar sign)

Uterus:

Visible soft density.

The body of the uterus develops steadily, making the shape of the uterus body almost a spherical shape that we can touch when we put a finger in the pocket on the same side of the vagina, which is a Noble sign: that the uterus is enlarged.

The volume of the uterus increases gradually with the development of the fetus.

From month 2, each month, the uterus is 4 cm above the joint.

Signs of Piszkacsek: At the nesting site of the egg you can see that the uterus is slightly swollen, causing the uterus to lose its symmetry along its axis.

On examination it can be seen that uterine contraction is characteristic of the uterus during pregnancy, is a valuable sign (limited examination because it is prone to miscarriage).

Subclinical symptoms

Find hCG (Human chorionic Gonadotropin) in the urine.

Biological reaction:

Gallimainini: Quantification of hCG in urine. Normally, the amount of hCG in the urine is less than 20,000 units of frog. During egg pregnancy, the amount of hCG is over 20,000 units of frog.

Friedman Brouha: Normally the hCG level is less than 60,000 rabbit units, when over 60,000 rabbit units is pathological.

Wide Gemzell Immune Response.

Doppler amplifies the fetal heartbeat.

Ultrasound shows images of amniotic fluid, echoes of the fetus, fetal heart ... depending on gestational age. Subclinical tests are usually done only in the early days of pregnancy when clinical symptoms are not clear (especially when differential diagnosis is required with uterine conditions).

Implementing the quadrants

Based on clinical, subclinical symptoms.

Differential diagnosis

Differential diagnosis from functional symptoms

Menopause:

In people with irregular periods, those who take oral contraceptives.

Pathological amenorrhea (lactation, premenopausal disorders).

There are those who give birth who never get a period, but if there is bleeding, they are pregnant (pigeon blood).

Pathological state of mind that causes a woman to stop periods for a while, infections, some general illnesses.

Choking:

Hypothesis: Imagine being pregnant in someone who wishes to have a baby or is afraid of becoming pregnant.

Nausea, vomiting, and increased salivation due to other causes such as mental illness, internal medicine, and surgery.

Differential diagnosis with uterine symptoms of enlargement and softening of the uterus during pregnancy needs to differentiate from some cases of uterine and ovarian diseases such as:

Ovarian cyst: Cyst is located close to the uterus, the woman is still menstruating, has no morning sickness, the uterine density is normal, the size of the uterus is normal, the tumor cell is isolated from the uterus, HCG is negative. , no pregnancy ultrasound in the uterus and uterine edge has pictures of the ovarian cyst.

Fibroids:

Menstrual disorders like menstruation: Time to see menstruation gradually increases, the number of menstruations gradually increases.

No morning sickness, no changes in the vagina or cervix.

The uterine body is large, firm density, can detect the roughness of many fibrous nuclei.

Volumetric uterine fibroids develop slowly

In the urine hCG test, in uterine fibroids hCG (-)

Ultrasound does not show pregnancy in the uterus

Uterine fibroids just pregnant:

Rely on ultrasound for diagnosis.

In addition, it is also important to distinguish between normal pregnancy or pathological pregnancy: ectopic pregnancy, pregnancy, stillbirth, it is necessary to combine clinical and subclinical symptoms for differential diagnosis depending on each specific disease.

Diagnosis of pregnancy in the next 4 and a half months of pregnancy

Symptom

Amenorrhea: Still missed periods.

Morning: Usually this stage is over.

Physical symptoms

The changes in the skin and breasts are more pronounced than in the early stages.

Vagina, cervix: Clear purple, softening.

The uterine body enlarges each week as the fetus develops.

Examination

Manipulation:

See parts of the fetus: Head, back, limbs, and buttocks of the fetus.

Seeing the movements of the fetus, even the pregnant person can feel it.

Hearing: Using a normal obstetric stethoscope, can hear the fetal heart and distinguish it from the mother's pulse.

Subclinical symptoms

The hCG in the urine usually has a low result, only when a stillbirth is suspected.

Ultrasound: See images of the fetus in the womb, fetal heart, placenta, amniotic fluid ...

Implementing the quadrants

Based on historical exploration and laboratory tests

Differential diagnosis

Enlarged ovarian tumors

There is no fetal movement, cannot hear the fetal heart, cannot see parts of the fetus.

Careful and careful examination can reveal a small uterus below, a large tumor located above.

Rely on X-rays, ultrasound and hCG to combine the diagnosis.

Enlarged uterine fibroids

The density of the uterus is stiff, firm, and can be seen with a lot of fibrous nuclei.

Uterine fibroids are usually late to detect.

Necessary may be based on subclinical tests: ultrasound, hCG in the urine.

Ascites

It is necessary to exploit the medical and surgical diseases accompanied by examination: the uterus is small, knocking chisel on the sides of the ribs, showing signs of flapping waves.

Rely on subclinical tests to diagnose.