December 24, 2013

Diagnosis of pregnancy in first trimester

The reproductive period of a woman begins at menarche (Menarche is the first 
menstrual cycle or first menstrual bleeding in females) and ends in menopause. 
It usually extends from 13-45 years. pregnancy is rare below 12 years and 
behind 50 years.

Diagnosis in first trimester - 

Subjective symptoms -
The following are the presumptive symptoms of early months of pregnancy.
           - Amenorrhoea
           - Morning sickness - It usually appears soon after following the missed
              period and rarely last behind the 3rd months.
           - Frequency of micturition - It is the quite common symptoms during
              8th to 12th week of pregnancy.
           - Breast discomfort - breast discomfort in the form of feeling of fullness
              and ''prinking sensation'' is evident early as 6 to 8 weeks.
           - Fatigue is a frequent symptoms which may occur early in pregnancy.


Que. - Why the frequency of micturition increases in pregnancy ?
Ans. -  It is due to -
           i)  Resting of the bulking uterus on the bladder because of exaggerated
               anteverted portion of the uterus.
          ii)  Congestion of the bladder.


Objective signs - 

1. Breast changes - The breast are enlarged and often contain milk for years.
The breast changes are evident between 6-8 weeks. Their is enlargement with
vascular enlargement evidented by the dedicated vein visible under skin.
The nipple and areola becomes mare pigmented specially in dark women.

2. Per abdomen - Uterus remains a pelvic organs until 12th week, it may be just
felt per abdomen as a suprapubic bulge.

3. Pelvic changes - 
a)  Chadwick's sign - Blue or purplish coloration of vaginal mucous membrane in pregnancy.
b)  Vaginal sign - The walls becomes softened. Their is increased pulsation felt through
      the lateral fornices at 8th week called osiander's sign.
c)  Cervical signs -
  -  Cervix becomes soft as early as 6th week known as goodle's sign.
  -  On speculum examination the bluish discoloration of cervix is visible.
      It is due to increased vascularity.

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