Pregnancy Dr Mohd Asrarul Haque Pregnancy It is

Pregnancy Dr Mohd Asrarul Haque

Pregnancy • It is a physiological condition develops in a female within her child bearing age due to fertilisation of ova by spermatozoa results in developing embryo or foetus in the uterus till its birth. • Signs of pregnancy in living: 1. Presumptive signs 2. Probable signs 3. Positive or conclusive signs

Presumptive signs of pregnancy • • • Amenorrhoea Morning sickness Changes in breasts Changes in the Vagina Urinary disturbances- increased frequency of micturition Chloasma - 24 th week Quickening - 16 – 20 weeks Linea nigra - 20 th week Striae gravidarum Sympathetic change -increased salivation -PICA (perverted appetite) -irritable temper.

• Changes in Breasts : • Breasts enlarged & nodular(2 nd month) • Surface veins prominent • Areola enlarged, pigmented with prominent Montgomery’s tubercles (2 nd month). • Nipples enlarged • Colostrum (3 rd month). • Changes in Vagina : • Jackquemier’s sign or Chadwick’s sign: violet or bluish discolouration of vaginal mucosa (after 4 th week).

PROBABLE SIGNS OF PREGNANCY • Enlargement of abdomen • Height of uterus. • Palmer’s sign- regular rhythmic contractions of uterus at 4 th to 8 th week.

Fundal height

• Hegar’s sign -Bimanual examination at 6 th - 8 th week

• Goodell’s sign -softening of cervix at 4 th month • Osiander’s sign – increase pulsation felt through lateral fornices at 8 th week • ‘Piskacek’s sign – asymmetrical enlargement of uterus if there is lateral implantation. Goodell’s sign

PROBABLE SIGNS OF PREGNANCY • Braxton-hick’s sign -After 1516 weeks of pregnancy • Ballottement: internal and external (during 4 th and 5 th month) External ballottement • Uterine soufflé at end of 4 th month • Biological tests : Presence of gonadotropins in pregnant woman’s blood and their excretion in urine Internal ballottement

• Immunological tests : a) Inhibition (Indirect) Latex slide test b) Direct Latex slide test • • Haemagglutination inhibition test. RIA and ELISA

POSITIVE SIGNS OF PREGNANCY • Auscultation of foetal heart sounds- positive after 18 -20 wks • Palpation of foetal part • Feeling foetal movements • Radiograph of foetus -after 3 months • USG : 6 wks - Gestational sac 7 wks - Embryo 10 wks - Heart beat 14 wks - Head and Thorax • Presence of foetal cells in mother’s blood.

Signs of pregnancy in Dead • Products of conception • Enlarged Uterus & other uterine change. • Corpus luteum

Medicolegal importance of pregnancy • In Civil cases: • Nullity of marriage • Inheritance of property • Higher maintenance allowance in case of divorce • Compensation cases • Illegitimate baby • Maternity leave • Compensation case if allegation of pregnancy against unmarried woman or widow.

In Criminal cases: • Execution of death sentence. • Advantage during trial in court. • It is positive proof in a trial of rape. • An unmarried pregnant woman bring a charge of criminal breach of trust against a man. • Adultery. • In criminal abortion and to foeticide or infanticide. • Motive for suicide or murder.

• Pseudocyesis / False Pregnancy / Spurious Pregnancy / Phantom Pregnancy. • Superfoetation • Superfecundation • Foetus Papyraceous / Foetus Compressus

• Fetus papyraceus is a rare condition which describes a mummified fetus in a multiple gestation pregnancy in which one fetus dies and becomes flattened between the membranes of the other fetus and uterine wall.