Gynecological examination
Pelvic ultrasound scan
Early pregnancy essentials
- Diagnosis of pregnancy is made on the basis of presumptive and definitive symptoms.
- It is crucial to diagnose pregnancy as soon as possible in order to initiate appropriate prenatal care, avoid teratogen exposure, and diagnose nonviable or ectopic pregnancies.
Presumptive symptoms & signs
- Amenorrhea of sudden onset is highly suggestive of pregnancy in reproductive age.
- Nausea & vomiting affects 50% of women between 2-16 weeks. Extreme forms (hyperemesis gravidarium) require hospitalization.
- Breast changes include tenderness (mastodynia), enlargement, colostrum secretion, and development of secondary breast tissue across the nipple line and in the axillae.
- Elevated basal body temperatue (0.5 C) persists after missed menses.
- Skin changes include chloasma (darkening of forehead and cheek), linea nigra (darkening of nipples and midlien down from umbilicus), striae (breast and abdomen), spider teleangiectasia.
- Pelvic organ changes include the Chadwick's sign (bluish discoloration of vagina and cervix); Hegar's sign (softening of uterine isthmus); leukorrhea; relaxation of pelvic ligaments; abdominal enlargement; Braxton Hick's contractions (painless, intermittent at 28 weeks onward).
- Pregnancy tests detect secretion of human chorionic gonadotropin by the embryonic trophoblast. Although typically indicative of pregnancy, hCG can be also increased in malignancies. More on hCG
Definitive signs
- Fetal heart activity is detectable by M-mode ultrasonography by 6 weeks.
- Fetal movements are first perceived at 18–20 weeks' gestation in primigravida and as early as 14 weeks' gestation in multiparous women.
- Fetal palpation is possible through the abdominal wall after 22 weeks.
Essentials of infertility workup
A couple is subfertile if they fail to conceive after one year of unprotected regular sexual intercourse.
Flowchart
Early investigation
Early investigation is warranted if
- her age > 35 years
- previous ectopic pregnancy
- history of pelvic inflammatory disease
- oligo- or amenorrhoea
- substantial fi