1. A VERY GOOD MORNING TO ALL MY
DEAR STUDENTS.

2. NURSING DIAGNOSIS creates a great sense for the
registered Nurse & registered Midwife in the care &
cure of the patient. It helps the Nurse to formulate a
comprehensive care plan for the one who depends on her
for his recovery. Hence, the Midwife must have
knowledge of all domains of Nursing Science in order
to work independently.
A woman moves through various stages
during her journey from birth to death. One of the
most challenging & exciting stage is PREGNANCY which
is meanwhile “The Mother of all hurdles &
uncertainty.”
Hence, this chapter will focus on the
proper management of Pregnancy by using Nursing
Diagnosis.

3. DIAGNOSIS OF PREGNANCY
PRESENTED BY
EMAIL: SAMITDWIBEDICONVIMSARBURLA@GMAIL.COM

4. PREGNANCY ? ? ? ? ? ? ?
gestation

5. HOW DO YOU KNOW ONE (SHE) IS PREGNANT?

6. ❖Nulligravida-
❖Primigravida-
❖Multigravida-

9. ❑Para: - It denotes a state of pregnancy beyond the period of viability.
❖Nullipara- One who has never completed a pregnancy to the stage
of viability.
❖Primipara- One who has delivered one viable child.
❖Multipara- One who has completed two or more pregnancies to the
stage of viability or more.
e.g.- …………!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

10. A woman with a
previous history of
two abortions and one
term delivery can be
expressed as ????

11. “”PRIMIPARA””
✓Parity is not
increased even if the
fetuses are many.

12. ❑POG: - Period of Gestation
❑EDD: - Expected Date of Delivery
❑Conceptional Age: - Age of the fetus calculated from the day of
fertilization.
❑Gestational Age/ Period: - The number of completed weeks of fetal
development calculated from the first day of last menstrual cycle.
❑Parturient: - A woman in labour.
❑Puerpera: - Who has just given birth.
❑Perinatal: - The time surrounding the baby’s birth; denotes a period
between 20 weeks of gestational age to 28 days after birth.

13. ❑Preterm: - Delivered before 37th week
❑Early term: - Delivered between 37th – 38th week and 6 days.
❑Full Term: - Delivered between 39th - 40th weeks and 6 days.
❑Late term: - Delivered at 41st week
❑Post term: - Delivered after 42th week.

14. DURATION OF PREGNANCY
Now a days, pregnancy is usually considered to be as follows: -
❑Days: - 280 days
❑Weeks: - 40 weeks
❑Months: - 9 calendar months and 7 days
The Total Period is divided into 3 trimesters.
❑First trimester- 1st to 12 weeks (12 weeks)
❑Second trimester- 13th to 27th week (15 weeks)
❑Third trimester- 28th to 40th weeks (13 weeks)

15. DIAGNOSIS OF PREGNANCY
Principles of diagnosis:
❑In most of the women, the diagnosis of pregnancy is usually
straightforward based on a history of amenorrhea and a
positive pregnancy test.
❑Women with irregular periods or vaginal bleeding, the
diagnosis of pregnancy is more complex.
❑Other symptoms of pregnancy may alert the clinician to the
possibility of pregnancy.
❑Diagnosis of pregnancy, in the first trimester and early second
trimester, is based on a combination of presumptive &
probable signs of pregnancy.

16. ❑Presumptive/Subjective symptoms of Pregnancy: Maternal
Physiological changes, which the woman experiences and which
indicate her that she is pregnant.
❑Probable/Objective signs of Pregnancy: Maternal Physiological
changes, which are detected upon examination & documented by the
examiner.
❑Positive signs of Pregnancy: Directly attributable to the fetus as
detected & documented by the examiner.

17. CONFIRMED DIAGNOSIS OF PREGNANCY
❑Detection of hCG in either Serum or Urine:
✓Serum hCG is not estimated routinely except after ART (Assisted
Reproductive Techniques).
✓UPT (Urinary Pregnancy Test) can diagnose pregnancy as early as 5
weeks (35 days from LMP) i.e. 7 days after the 1st missed period in
a woman having previous history of regular menstrual cycle.
UPTSPT

18. ❑Detection of gestational sac by Transvaginal
Sonography:
✓TVS can detect a Gestational Sac as early as 5 weeks (35 days from
LMP).
✓Yolk Sac by 37-40 days
✓Fetal Pole with pulsation by 40-45 days.
✓It can Confirm the Pregnancy
• Locate the Site
Determine the No of Fetuses
• Identify any abnormality of Pregnancy

19. Clinical Examination:
✓It implies Bimanual Examination.
✓Diagnose pregnancy as early as 8 weeks in the absence of
any Presumptive symptoms & Probable Signs.

20. PREGNANCY CHANGES DURING THE FIRST
TRIMESTER (FIRST 12 WEEKS)
PRESUMPTIVE/ SUBJECTIVE SYMPTOMS:
Cessation of Menstruation (Amenorrhoea): 4th Week
❑In normally menstruating women, the abrupt cessation of
cyclic and regular periods is strongly suggestive of pregnancy.
❑Cyclic bleeding may occur up to 12 weeks of pregnancy and
is usually scanty, lasting for short duration. It is known as
Placental Sign or Implantation bleeding.
❑Shouldn’t be confused with Threatened Abortion.

21. Morning Sickness (4th – 14th Week):
❑More often seen in first pregnancy than subsequent one.
❑Usually appears soon following the missed period & rarely lasts
beyond the first trimester.
❑Intensity varies from nausea on rising from the bed to loss of
appetite or even vomiting.

22. Frequency of Micturition (6th – 12th Week):
❑It is due to:
➢The pressure from the enlarging gravid uterus on the fundus of the
bladder
➢Congestion of the bladder mucosa
❑This symptom is relieved when the growing uterus becomes an
abdominal organ.
❑It again returns towards full term when the fetal head engages in the
pelvis.

23. Breast Discomfort (6 – 8 Weeks):
❑Usually seen in primigravida.
❑Feeling of fullness & Pricking Sensation in the breasts.

24. Fatigue (4th Weeks onwards):
❑Tiredness is an early symptom.
❑Some women complain of sleepiness
and disinclination to work.

25. Feeling of warmth and sweating:
❑Some women complain of feeling
feverish and excessive sweating.
❑This is usually due to altered circulation
in the skin.

26. Objective/Probable Signs:
❑Breast Changes (6 – 8 Weeks): -
➢Enlargement of breasts along with vascular
engorgement evidenced by the delicate veins
visible under the skin.
➢Increase pigmentation of
nipple & areola (primary).

27. ➢Montgomery’s tubercles (sebaceous
or oil glands that appear as small bumps
around the dark area of the nipple)
are prominent.
➢Their primary function is lubricating and
keeping germs away from the breasts.
➢Secretion of colostrum by 12th week.

28. ❑ Per Abdomen:
➢Uterus remains a pelvic organ until
12th week.
➢It may be just felt per abdomen as
a suprapubic bulge.

29. ❑ Pelvic Changes:
➢Jacquemier’s or Chadwick’s Sign:
❖Dusky hue of the vestibule & anterior vaginal
wall by 8th week of pregnancy.
❖It is due to local vascular changes.

30. ❑ Vaginal Sign:
➢Soft anterior vaginal wall
➢Copious non-irritating mucoid discharge by 6th
week
➢It is due to increased hormones level and vaginal
blood flow.
➢Increased pulsation in the lateral fornices by
8th week (Osiander’s Sign).

31. ❑ Cervical Signs:
➢Cervix becomes soft around
6th week (Goodell’s Sign).
➢Cervix feels like the lips of the mouth.
➢Bluish discolouration of the cervix
found on speculum examination.

32. ❑ Uterine Signs:
➢Size: -
❖Hen’s Egg at 6th Week
❖Cricket Ball at 8th Week
❖Fetal Head at 12th Week
➢Shape: - Globular at 12th Week
➢Consistency: -
❖One half is more firm than the other half (Piskacek’s Sign).
❖Uterus feels soft & elastic.

33. Hegar’s Sign:
➢Upper part of the body of the uterus is
enlarged by the growing fetus
➢Lower part is of the body is empty &
extremely soft
➢Cervix is comparatively firm.
This can be elicited by Bimanual Examination where the abdominal
& vaginal fingers seem to appose below the body of the uterus.

34. Palmer’s Sign:
➢Regular & rhythmic uterine contraction as early as 4-8 Weeks.
➢Can be elicited by Bimanual Examination: -
❖Where the uterus is cupped between internal & external fingers for
2-3 minutes
❖During contraction, uterus becomes firm & well defined
❖Soft & ill defined during relaxation.

35. Special Investigation: -
❑Detection of hCG: -
➢UPT is the commonly used lab test to detect pregnancy.
➢It detects the Beta-Sub unit of hCG in as low as 25 IU/L of Urine.
➢Serum quantitative tests are more reliable & accurate, but are
expensive & rarely used in ART to assess the growth of fetus or to
rule out any abnormality during pregnancy.

36. High Resolution Ultrasonography:
➢Detection of Gestation Sac, its location & number is generally
possible as early as the 5th week of gestation on TVS.
➢TVS can detect Fetal Viability & Gestational Age as follows:
❖Gestational Sac by 5th Weeks
❖Fetal Pole & Cardiac Activity by 6th Weeks
❖Embryonic Movements by 7th Weeks
❖Fetal Gestational Age by measuring the CRL between 7-12
Weeks
➢Doppler USG can detect Fetal Heart Rate (FHR) by 10th
Weeks.

37. Ultrasonography:
CRL MEASUREMENT

38. Q: How can you
diagnose a
pregnancy in
early weeks as a
Midwife ?