Assesment of Normal Pregnancy

Extract

[...] Globe Assesment of Normal Pregnancy DIAGNOSIS The diagnosis of pregnancy is usually made on the basis of a history of amenorrhea, an enlarging uterus, and a positive pregnancy test. Nausea and breast tenderness are also often present. It may be crucial to diagnose pregnancy before the first missed menstrual period to prevent exposure of the fetus to hazardous substances x-rays, teratogenic drugs), to manage ectopic or nonviable pregnancies, or to provide better health care for the mother. The manifestations of pregnancy are classified into 3 groups: presumptive, probable, and positive. [...]

[...] Positive Manifestations The various signs and symptoms of pregnancy are often reliable, but none is diagnostic. A positive diagnosis must be made upon objective findings, many of which are not produced until after the first trimester. However, more methods are becoming available to diagnose pregnancy at an early stage. A. FETAL HEART TONES (FHTs) It is possible to hear FHTs with a fetoscope in a slender woman at 17–18 weeks. The normal fetal heart rate is 120–160 beats per minute. [...]

[...] X-RAY OF FETUS X-ray films should be avoided in pregnancy to protect the mother and fetus from possible genetic or oncogenic risk. However, if the potential benefit outweighs the risk, radiographs may be of value. A large body of radiographic data exists about pregnancy. The ossified fetal bones appear at 12–14 weeks. Before 16 weeks, bowel shadows and pelvic bone configuration often conceal a pregnancy in the anteroposterior view. An oblique view of the lower abdomen is most likely to show the fetal skeleton. [...]

[...] Regression curves have been developed to determine normal hCG disappearance in each of these conditions, but they are difficult to apply to specific cases because of varying circumstances among patients. For example, minimal residual trophoblast in the uterus after a D&C may delay the fall in hCG levels. In such cases, it may be important to at least establish that levels are falling and eventually reach nonpregnant values. A. BIOLOGIC TESTS Biologic tests have been replaced by more sensitive and economical methods. [...]

[...] Intestinal peristalsis may be mistaken for fetal movement; therefore, perceived fetal movement alone is not a reliable symptom of pregnancy, but may be useful in determining the duration of pregnancy Urinary tract— a. Bladder irritability, frequency, and nocturia—These conditions occur because of increased bladder circulation and pressure from the enlarging uterus. b. Urinary tract infection—Urinary tract infection must always be ruled out because pregnant women are more likely than nonpregnant women to have significant bacteriuria which may be asymptomatic versus B. [...]