Gynaecology and Obstetrics
The first sign of pregnancy and the first reason why most women are pregnant consult a doctor, is the absence of a menstrual cycle.
In a patient who usually regular cycles and is sexually active, the absence of menstruation, continued for 1 week. Is a presumptive sign of pregnancy. You may also notice breast engorgement and nausea, occasionally accompanied by vomiting.
The breast swelling is due to increased levels of estrogen (primarily) and progesterone and is a continuation of premenstrual engorgement. Nausea and vomiting can be caused by human chorionic gonadotropin (hCG) and estrogen, the syncytial cells of the placenta begin to produce increasing amounts already 10 days after conception.
The corpus luteum of the ovary is stimulated by hCG to continue to secrete high levels of estrogen and progesterone to support pregnancy. Many women in this period, some patients feel tired and notice an increase in volume of the abdomen (distention).
The gestational age is generally calculated in weeks. from the first day of the last menstruation. So if the patient had regular cycles and ovulation occurred if the 14th day of the cycle, the dates midwives are longer than 2 weeks. than embryological. If cycles are irregular, the difference is greater or less than 2 weeks. Typically, 2 weeks. after failing to menstruation, the patient is seen 6 weeks pregnant. and the uterus is enlarged accordingly.
The pelvic examination revealed an increase in volume of the uterus incompatible with pregnancy. The cervix is softer and the uterus is irregularly decreased consistency and increased volume. The cervix becomes, usually bluish or purple, due to uterine blood flow.
The test blood or urine is generally positive. The immunoassay of hCG (Enzyme-linked immunodeficient assay, ELISA) may allow rapid and accurate determinations of the presence of even small quantities of this hormone in urine. Some of the most sensitive pregnancy tests using this method (eg., ICON, testpacks) can provide positive results in about 1 / 2 h with hCG levels that are also just 50 mIU / ml of urine, these levels are observed often several days before menstruation failure. With radioimmunoassay, which use antibodies specific for the b subunit of hCG (beta-hCG), hCG levels can be detected even lower (a minimum of approximately 0.05 mIU / ml serum with most of these tests). Thus, pregnancy can be diagnosed several days after conception.
During the first 60 days of a normal singleton pregnancy, hCG levels double approximately every 2-3 days, increasing exponentially. Although in normal pregnancy hCG levels correlate with gestational age, the use of different standards for the measurement of hCG, the variations between different tests and the biological variability, are unable to determine, based on a single value hCG, if the fetus is growing normally. The best method is to compare two values of serum hCG, obtained 48-72 h apart and measured by the same laboratory, a doubling of the values of hCG is highly predictive of normal fetal development. In pathological pregnancy (eg. The miscarriage, the “blighted ovum”, ie the absence of the embryo sac gestational empty, ectopic pregnancy), hCG levels are lower than normal and do not double every 2-3 days.
At the sixth week. gestation, the uterus can sometimes be easily flexed on the isthmus that is noticeably softened. At the 12th week. the uterus is larger than the pelvic cavity from the pelvis back and abdomen, becoming palpable above the symphonists pubis. At the 20th week. of gestation, the uterus has reached the transverse umbilical line (from the uterus to the pubic symphonic is about 20 cm) to the 36th week. the bottom is near sternum.
The proof of pregnancy is a certainty, of course, the birth of a fetus. Traditionally, three others are considered signs of certainty: the fetal heartbeat heard by the physician, either directly or through a Doppler ultrasonic instrument (usually the fetal heart sounds can be detected with a stethoscope to the 18th to 20th week. Gestation and even the 10th to 12th week. with a Doppler, if the uterus is accessed via abdominal), fetal movements perceived or heard from the doctor performing the visit, the radiological identification of the fetal skeleton, usually after the 16th week. Even the highlight of an ultrasound room and gestational intrauterine fetal cardiac activity are evidence of certainty.
The presence of a cavity inside the uterus, which is compatible with pregnancy, can be identified at about the fifth to sixth week. (4 weeks. After ovulation) with ultrasound. The movement of the fetal heart can be visualized by ultrasound in “real time” as soon as the fifth-sixth week. and 7th-8th week. in> 95% of cases. The pregnant woman usually begins to feel fetal movements between the 16th and 20th weeks. gestation.
Pregnancy is considered age at the 266th or 280th day after conception from the first day of the last menstrual period, if the cycles were regular and 28 days. Angele’s rule calculates the estimated date of delivery by subtracting three months from the first day of the last menstrual period and adding seven days. This calculation is only approximate, 10% of patients giving birth on the day appointed, while 50% do so within 1 week. and nearly 90% within 2 weeks. Therefore patients should be informed that deliver up to 2 weeks. before or after the estimated date is normal.
A pregnant woman is defined as a pregnancy. Each pregnancy (that is considered one multiple pregnancy), the number to accompany the word “pregnant”, so a patient who has had two confirmed pregnancies is fraught II. Equality describes the outcome of pregnancy. The term para refers to shares which occurred after the 20th week., Which are then numbered so that the patient will be defined as in para 1, 2, 3 and so forth (the twins, childbirth trigeminus or multiple births are considered a para ).
Abortion refers to a birth that occurs before the 20th week. as abortion and is serially numbered 1, 2, 3 and so on. The sum of parameters (equal) and gives the total number of abortions of pregnancies. More often, gender is indicated by four numbers: the first is the number of births at term (after the 37th week.),
The second the number of premature births (> 20 and <37 weeks.), The third is the number of abortions and the fourth the number of children alive. Therefore, a woman who is pregnant and had a pregnancy to term, a pair of twins born at the 32nd week. and two miscarriages, should be defined as pregnant 5, para 1-1-2-3.
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