Diagnosis of pregnancy

OBSTETRICS
Lecture: 2.
Fourth Year Medical College.
Lecturer: Professor Layla Abdul Amir.

Diagnosis of pregnancy
1. Diagnosis by detection of Human Chorionic gonatotrophin: This is detected either in maternal urine after 14 days from the time of amenorrhoea by immunological test, or we can detect it earlier (from the time of implantation) in the serum in which we detect ? fraction of the hormone in the serum by radio immunoassay.
High concentrations of HCG are seenin:
- Multiple pregnancy.
- Hydatidiform mole.
- Choriocarcinoma.
The test is weakly positive in some cases of missed abortion.
2. Ultrasound diagnosis of pregnancy: gestational sac can be diagnosed at early five weeks from first day of the last menstrual period, and a week later echoes representing the embryo within the sac and cardiac pulsation can be recognized also.
3. Radiological diagnosis of pregnancy: Fetal bones can be seen by radiology in about 16th week of pregnancy, but usually we not take radiology for a pregnant women because it may cause intrauterine death.
Differential diagnosis of pregnancy:
The pregnant uterus should be differentiated from other abdomino-pelvic swelling as:
1. Uterine fibromyomata: these tumours are deeply placed in uterus, usually accompanied by sever bleeding at each monthly period.
Pregnancy test = negative, no signs of pregnancy.
2. Ovarian cysts: uterus is normal in size when palpated bimanually. Pregnancy test negative, no signs of pregnancy.
Ovarian tumours accompanied by amenorrhoea during the reproductive period, if they bilateral and totally destroying both ovaries.
Thrill or fluctuation is common with ovarian cyst.
3. Distended bladder: due to retention of urine because of retrogravid uterus, so passing of catheter show the type of swelling.
4. Pregnancy associated with fibromyomata. Pregnancy test and ultrasound examination will be of value in early pregnancy to differentiate between them.
Fibromyomata in uterine wall is immobile, while fetal limbs alters its position from time to time.
Also when uterus contract, fibromyomata more evident, while fetal parts become more difficult to felt.
5. Pregnancy associated with ovarian cyst. Two swelling is present (pregnant uterus and the cyst) and this can be differentiated by using ultrasound scan. (usually signs of pregnancy are present).