Diagnosis of pregnancy..

A healthy married woman who has been mensturating regularly Misses a period.
In 98%of cases this is due to pregnancy.
In these days the advanced diagnostic tests such as USG, Immunological test for pregnancy has reduced or eliminated the needs to rely on the more inaccurate presumption of probable signs of pregnancy....
1) First trimesters (1 to 12 weeks)
2) Second trimesters (13 to 26 weeks)
3) Third trimesters (27 to 40 weeks)
  
First day of last menstrual cycle = 40weeks or 280 day is known as gestational age or Manstural age

For ovulation 38weeks or 266day is known as ovulatory age or Fertilization age.

Antenatal checkup....
   
According to WHO 4 Antenatal visit..
1) First visit- 12weeks
2) Second visit-24 to 26 weeks
3) Third visit- 32 weeks
4) Fourth visit- 36 to 38weeks
 
Generally...
Up to 7th month- 1 visit/month
          8th month-2 visit
          9th month -4 visit
Total 13 visit of antenantal visit
1) Diagnosis of first trimester
 a) Symptoms
         
Amenorrhea
     
 Morning sickness ( nausea, vomiting)
       
 Breast tenderness 6 to 8 weeks
         
Urinary urgency and frequency increase
   b) Sign
          Jacquemier's sign -bluish discoloration on vagina at 8th weeks
          Chadwick sign-  
          Osionder sign- pulsation feel lateral fornix due to spiral artery at 8th weeks
         Goodle's sign- softing of cervix at 6th weeks
         Hegar sign- softing of lower uterine segment at 6 to 10 weeks
        Palmer sign- rheythemic regular uterine contraction at 4 to 6 weeks
c) Diagnosis in first trimesters test
 Immunological test
Positive pregnancy test
Gestational sac 5weeks are present
Montogomery tubercal 12 weeks are present
Fetal heart sound.by the electronic devices (Doppler transducer) 10 weeks
2) Second trimester 13 to 28 weeks
  Symptoms
Quicking (feeling of life) denotes the perception of active fetal movements by the women.
It is usually felt about the 18th weeks , about 2weeks earlier in multiparae.
Progressive enlargement....Of the lower abdomen by the growing uterus
General examination
 Chloasma pigmentation -over the forehead and cheek may appear at about 24th weeks
Breast change- breast are more enlarged with prominent veins under the skin
Secondary areola specially demarcated in primigravida, usually appears at about 20th weeks
Abdominal examination
Skin change
 
Linea nigra 20 weeks
 
Striae gravidarum 20weeks
   
Chloasma 24weeks
Braxton Hicks contractions
 
Painless irregular uterine contractions 16 weeks
Ballottement. Rebounds of fetus
External and internal ballottement
External.  Breech presentation ,per abdominal 20weeks
Internal.Vertex presentation,per vaginal 16 to 28 weeks
3)Third trimester
Symptoms
 Amenorrhoea
Enlargement of abdomen
Lightening 36 to 38 weeks fetus move downward known as Welcome sign og pregnancy
Frequency of micturition
Fetal movements
Sign
Cutaneous change
Uterine shape
Fundal height..

         

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Third Complications of labor

चित्र
All women who deliver are at risk of complications in third stage of labor.These complications include Post partum Hemorrahege Retention of placenta (Retained placenta) Inversion of uterus Plumonary embolism Obsteric shock Injurier of birth canal     Retained placenta Management 1) Fundal pressure 2) Controll word traction 3) Manual remove of placenta under Genearl Anesthesia 1) Fundal pressure After seperation of placenta Pressure=Dounword and backward pressure on funda part and pull out the umblical word 2) Controll card traction  placenta separate Pressure on symphysis punia upword and backward Pull out with umblical word 3) Manual remove of placenta under general anesthesia Placent not seperat Female=General Anesthesia (Thiopentel sodiyam 4 to 5 mg/kg) Wear the gloves and insert hand in cone shape manner And reach hoti placenta margin Slicing movemen
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Anatomy and physiology of Vagina to prevent infection

चित्र
In adult female ,vagina is lined by stratified squamous epithelium.In newborn female,it is lined by transitional epithelium.squamous epithelium is resistant to gonococcal infection.Thus , gonococal vaginitis cannot occur in adult female. Vagina has local inhabitant bacteria called Doderlein's bacillus Which breaks down the glycogen present in vaginal epithelium into lactic acid resulting in acidic pH(4-5.5, average 4.5) of vagina.The acidic pH of vagina acts as a barrier for external organism and protect from infection. Physiological vaginal discharge..... Clear, white and flocculent odourless discharge. Smear contains epithelial cells, lactobacillus pH ranges from 3.8 to 4.2 pH increase with increased oestrogen States:in pregnancy,OCP,mid-cycle,PCOS or premenarchal If pH increase in primenopausal woman, investigation for other effects of excess oestrogen. This area is subject to both primary and secondary infection.Ascending infection can occur from the vagina and c
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Antepartum Heamorrhage APH

चित्र
Antepartum haemorrhage APH APH is usually define as bleeding form the birth canal after the 24 to 28 weeks of  pregnancy.It can occur at any time until the second stage of lobour is complete; bleeding following the birth of the baby is postpartum haemorrhage=Miscarriage Or  Any ammount of bleeding from genital tract after 28 weeks to before of bleeding 28wk ..... Delivery time....6wk APH_________IPH_________PPH ETIOLOGY  --- Idiopathic/unknown 2types    1) Placenta previa (pp) 2) Abrupto previa (AP) Placenta previa=in lower uterin segement Implantation posterior wall of bady of uterus near the fundus Abrupto precisa=premature separation of placenta Most common risk of APH Dropping down theory= Drop down in lower uterine segments Implantation Due to less endometrial reactions Increase that cilliary active of fallopian tube A)Types of placenta previa 1)Types 1 (PP)  low lying place
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