Diagnosis of pregnancy and
routine prenatal care
Ai-Xia Liu
Women’s Hospital School of Medicine
Zhejiang University
Part I
Pregnancy: defined as the maternal
condition of having a developing embryo or
fetus in the body.
Oocyte and sperms
Lennart Nilsson (born 1922) is
a Swedish photographer and
scientist. He is noted for his
photographs of in vivo human
embryos in 1965.
fertilization
Only one sperm can
penetrate
through the zona
pellucida of oocyte
Implantation
11w fetal
20w old fetal is
sucking his thumb
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Embryo: 0-8weeks
Fetus: 9-40weeks
The duration of pregnancy
 Gestational age: It is calculated from
the first day of the last menstrual
period (LMP, assuming a 28 day cycle)
and expressed in completed age
 Fertilization age: the age of the
offspring calculated from the time of
fertilization
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Gravidity: the total number of pregnancies
(normal and abnormal)
Parity: the state of having given birth to
an infant or infants weighing ≥500g, alive
or dead. (A multiple birth is a single
parous experience)
Live birth: the complete expulsion or
extraction of a product of conception from
the mother, which shows evidence of life
Pregnancy diagnosis
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Pregnancy is divided into three phases,
called trimesters
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First trimester: 0 - 12 weeks
Second trimester: 13 - 27 weeks
Third trimester: 28 - 40 weeks
First trimester pregnancy
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Symptoms
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Amenorrhea: strongly suggestive of pregnancy
Nausea
morning sickness of pregnancy (4-12W)
results from rapidly rising serum levels of HCG
Fatigue: one of the earliest symptoms of
pregnancy
Frequent urination
Signs
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Increased basal body temperature
Breast tenderness
Chadwick's sign (darkening of the cervix,
vagina, and vulva),
Goodell's sign (softening of the vaginal
portion of the cervix),
Hegar's sign (softening of the uterus
isthmus),
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Skin change: increased pigmentation
including chloasma, linea nigra,
stretch marks
chloasma
linea nigra
stretch marks
First trimester pregnancy
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Bleeding (25%)
Spontaneous abortion (25-50%)
Uterine cramping with bleeding in the
first trimester is suggestive of
impending abortion
Pregnancy test
Human chorionic gonadotropin (HCG) is
produced by trophoblasts from 8 days after
fertilization
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Urine pregnancy test
Serum pregnancy test: more sensitive

HCG may be detected in maternal serum
in 9 days
Positive manifestations
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Fetal heart tone
(120-160 BPM)
Doppler device can detect at 10 weeks
Positive manifestations
• Ultrasound
examination of
fetus is one of
the most useful
technical way
Second trimester pregnancy

Symptoms
General well-being: the most
comfortable time for a pregnant
woman
 Pain: stretching of pelvic structures
 Uterine contraction (Braxton hicks
contractions)
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Second trimester pregnancy
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Abdominal enlargement:
quickening: primigravida 16-20 w
multigravidas 14-16 w
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Fetus: attains a size of almost 1000g
by 28w
Motion: begin at 16-20w
 Viability
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Positive manifestations
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Palpation of
fetus (22 weeks)
Leopold
Maneuver to
determine the
fetal
presentation
In obstetrics, the presentation of a fetus
about to be born refers to which
anatomical part of the fetus is leading,
that is, is closest to the pelvic inlet of
the birth canal.
According to the leading part, this is
identified as a cephalic, breech, or
shoulder presentation.
Longitudinal lie
Transverse lie
Third trimester pregnancy
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Symptoms
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Contraction: more apparent
Pain in the lower back and legs: pressure
on muscles and nerves by the uterus and
fetal head
Lightening: descent of the fetal head
weight gain: fetal grows rapidly
Fetal movement: regularly, strong
Part II
Routine Prenatal care
Prenatal care
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Preconception care
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Women who contemplate pregnancy should be
evaluated for the conditions that could affect a
future pregnancy
Routine prenatal care
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Every 4 weeks during the first 28 weeks of
gestation
Every 2 weeks from 28 to 36 weeks
Weekly from 36 weeks to delivery
The first prenatal visit
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Usually at the first trimester, most
thorough
History
 Physical examination
 Laboratory tests
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History
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Obstetrical history
Medical history
Family history
Social history
Complete obstetric history
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Present pregnancy and menstrual history
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Past pregnancies
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Estimated gestational age(EGA), EDC
The length and duration of menstruation
EGA at the time of delivery or abortion
Fetal outcome
Mode of delivery: vaginal or cesarean section
Complications: GDM, preeclampsia
Medical history
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Previous and current medical
disease
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Diabetes, chronic hypertension
Medication
Previous surgeries
Blood transfusion history
General history
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Family history
Diabetes
 Mental retardation
 Genetic disorders
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Social history and education
Physical examination
Physical examinations generally consist of:
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Checking (mother's) blood pressure
(Mother's) height and weight
Pelvic exam
Doppler fetal heart
rate monitoring
(Mother's) blood and urine tests
Physical examination
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Pelvic examination
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Evaluation for abnormal vaginal discharge
Performance of cervical culture
Assessment of pelvic soft tissue: cervix and
uterine
Bony pelvis
Clinical pelvimetry：
pelvic inlet, midpelvis and pelvic outlet
Laboratory Tests
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Blood screening
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Blood routine test
Blood type (ABO and RH)
Detect diseases: rubella, syphilis, hepatitis B,
HIV
Screening test for certain diseases according
family history
Diabetes screen: glucose challenge test (GCT)
Laboratory tests
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Urinalysis: bacteria, sugar, and protein
Pap smear :detection abnormal cells
Infectious disease: gonorrhea, chlamydia,
group B streptococcus, et al
Stool test when indicated
Tuberculin skin test for high risk patients
Laboratory tests
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Neural tube defects screening testing
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First trimester screening (10w3d-13w6d)
Nuchal translucency(NT) measurement+serum analytes
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Second trimester screening(15-20w)
Serum analyses: AFP+HCG+estriol (uE3)
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Diagnostic genetic testing
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Chorionic villus sampling (CVS) (10-12w )
Amniocentesis ( 16-18w )
Age>35 or abnormal pedigrees
Subsequent Visit
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Every 4w until 28(32)w
Every 2w until 36w
After 36 weeks, every 1 w until
delivery
Complicated pregnancies require
closer surveillance
Subsequent Visit
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Weight gain
Blood pressure
Fundal height
Abdominal examination fetal size and position
Fetal heart tones
Edema
Urine test