Summary of diagnosis of pregnancy : 

A. Positive or absolute signs : 

1. Palpation of the fetal parts & perception of active fetal movements by the examiner at about 20th week.
2. Auscultation of fetal heart sounds.
3. Ultrasound evidence of embryo as early as 6th week & later on the fetus.
4. Radiological demonstration of the fetal skeleton at 16th week & onward.

B. Presumptive symptoms & signs : It includes the features mainly appreciated by the women.

1. Amenorrhoea.
2. Increased frequency of micturition.
3. Morning sickness.
4. Fatigue
5. Breast changes.
6. Skin changes.
7. Quickeninng

C Probable signs : 

1. Abdomen enlargement.
2. Braxton-Hick’s sign
3. External & internal ballottement.
4. Outlining of the fetus.
5. Changes in the size, shape & consistency of the uterus.
6. Jacquemier’s sign
7. Softening of the cervix.
8. Osiander’s sign
9. Immunological tests

Solve a question about pregnancy :

• A mother within lactational amenorrhoea for one year complaining something moving inside her abdomen. What will be your approaches for diagnosis the case?

Answer : 

Provisional diagnosis :  Most probably this is a case of pregnancy.

Differential diagnosis : Ovarian tumour.

Approaches of the patient : 

1. Clinical approach : 

• Side to side & above downwards movement : If side to side & above downwards movement present — –> ovarian tumour : if not —> gravid uterus.
• Fundal height.
• Fetal heart sound. If FHS present – – -> pregnancy.

2. Investigations : 

• Immunological investigations / urine for pregnancy test.
• Ultrasonography : Confirmatory.