Diagnosis of Pregnancy in Second Trimester

Subject: Midwifery I (Theory)

Overview

Pregnancy signs and symptoms are classified into three stages: presumptive, probable, and positive. Presumptive symptoms include early breast changes, amenorrhea, morning sickness, bladder irritation, and quickening. Probable symptoms include the presence of HCG in urine and blood, Hegar's sign, Jacquemier's sign, Osiander's sign, Braxton hicks contraction, and uterine ballottement. Finally, positive signs include fetal visibility via USG, X-ray, or ultrasound. Fetal activity is visible and tactile, as are fetal components, which is known as quickening. At around 12 weeks, the expanding pregnant uterus extends out of the pelvis and becomes palpable abdominally in the suprapubic area. During the second trimester, an abdominal examination, a vaginal examination, and other tests are performed to diagnose the pregnancy.

Symptoms:

  • Amenorrhea 
  • Nausea and vomiting: The frequent urination complaints start to fade.
  • Breast changes 
  • Quickening: Women describe the fetal movement as a flutter or the sensation of bubbles inside between the 16th and 20th weeks. This is known as quickening. Multiparae experience a faster heartbeat than primigravidae.
  • Enlargement of the abdomen: At around 12 weeks, the expanding pregnant uterus extends out of the pelvis and becomes palpable abdominally in the suprapubic region. At 24 weeks, it reaches the umbilicus.

  • Skin changes: Darkening of the skin occurs in general, but it is more noticeable in the armpits, linea nigra, and breasts. Within 24 weeks, a butterfly-like coloring around the cheeks known as chloasma is visible. Striae gravidarum are stretch marks that develop on the lower belly, flanks, breast, and hips.

Clinical Examination

Abdominal Examination:

  • Inspection: It exhibits lower abdominal fullness, stretch marks, and linea nigra.
  • Palpation: Braxton hicks contractions are experienced. Between 18 and 20 weeks, bouncing the uterus between the palpating hands reveals the sensation of ballottement. This is known as external ballottement.

Vaginal Examination:

  • A speculum examination reveals that the cervix and vaginal mucosa are congested and bluish, and the vaginal discharge is creamy white.
  • Bimanual examination: Tapping the cervix after the 10th week reveals the presence of a baby, which goes away from the probing finger and subsequently returns with a thumb. This is a symptom of internal ballottement.
  • Auscultation: Fetal heart tones can be heard using a fetoscope or stethoscope between the 20th and 24th weeks of pregnancy. This is a very good symptom of pregnancy.

Investigation:

  • X-ray: The skeleton shadow can be noticed as early as 16 weeks, but it is not commonly used.
  • Sonography: This can detect not only the fetal skeleton and organs, but also the location of the placenta, the amount of amniotic fluid, and the internal os condition.

References

  • Medscape. 1994. 2017 http://emedicine.medscape.com/article/262591-overview#a3
  • GFMER. 22 September 2016 http://www.gfmer.ch/Obstetrics_simplified/Diagnosis_of_pregnancy.htm
  • BabyMed. 2001. 2017. http://www.babymed.com/tag/early-pregnancy-diagnosis#
  • WHO, UNFPA, UNICEF, 2003. Pregnancy, childbirth, Postpartum and Newborn care (PCPNC): A guide for essential practice, “IMPAC” World bank.
  • HealthLine. 2005. 2017 http://www.healthline.com/health/pregnancy/second-trimester-checkups-tests#Furthertesting3
  • Tuitui R. 2002, A textbook of Midwifery A (Antenatal), 3rd edition, Vidyarthi Pustak Bhandari (Publisher and Distributor), Bhotahity, Kathmandu
  • Web MD. 2005. 2017 http://www.webmd.com/baby/guide/second-trimester-tests#1
  • PinkWhaleHealthCare.  10 August 2015. http://pinkwhalehealthcare.com/blog/diagnosis-of-pregnancy-second-trimester/
  • Tuitui R. 2002, A textbook of Midwifery B (Intranatal), 3rd edition, Vidyarthi Pustak Bhandari (Publisher and Distributor), Bhotahity, Kathmandu
Things to remember
  • The signs and symptoms of pregnancy are classified into three stages: presumptive, probable, and positive.
  • Early breast changes, amenorrhea, morning sickness, bladder irritation, and quickening are all presumptive signs.
  • HCG in urine and blood, Hegar's sign, Jacquemier's sign, Osiander's sign, Braxton hicks contraction, and uterus allocation are all possible symptoms.
  • Positive indicators include the visualization of a fetus via USG, X-ray, or ultrasound.
  • Fetal activity is apparent and tactile, as are fetal components.
  • Women describe the fetal movement as a flutter or the sensation of bubbles inside between the 16th and 20th weeks. This is known as quickening.
  • At around 12 weeks, the expanding pregnant uterus extends out of the pelvis and becomes palpable abdominally in the suprapubic region. At 24 weeks, it reaches the umbilicus.
  • Darkening of the skin occurs in general, but it is more noticeable in the armpits, linea nigra, and breasts. Within 24 weeks, a butterfly-like coloring around the cheeks known as chloasma is visible.
  • During the second trimester, abdominal examination, vaginal examination, and several investigations are performed to diagnose the pregnancy.
Questions and Answers

Symptoms

The symptoms include

  • Abdominal enlargement
    • At around 12 weeks, the growing pregnant uterus emerges from the pelvis and can be felt abdominally in the suprapubic area. At 24 WOG, it touches the umbilicus.
  • Quickening
    • Women feel fetal movement between weeks 16 and 20, describing it as a flutter or bubble-like sensation inside. We refer to this as quickening. Primigravidae experience a quickening later than multiparae.
  • Amenorrhea persists
  • Vomiting, nausea, and complaints of frequent urination start to pass.
  • Ongoing breast changes
  • Skin changes
    • Skin darkening is a common occurrence, although the armpit, linea nigra, and breast areas are where it is most obvious. Within 24 weeks, chloasma, a coloring around the cheeks that resembles a butterfly, is noticed. Striae gravidarum, also referred to as stretch marks, develop on the lower belly, flanks, breast, and hips.

Clinical Examination

  • Abdominal Examination
    • Inspection
      • It reveals linea nigra, stretch marks, and fullness in the lower abdomen.
    • Palpation
      • One can feel a braxton hicks contraction. External ballottement is felt when the uterus is rocked between the palpating palms between weeks 18 and 20. External ballottement is the name of this sign.
  • Vaginal Examination
    • A speculum examination reveals a congested, bluish appearance to the cervix and vaginal mucosa, and a creamy white discharge.
    • Bimanual examination
      • When the cervix is tapped after the 10th week, a baby is seen, which moves away from the examination finger and then comes back with a thumb. This signal is referred to as an internal ballottement.
    • Auscultation
      • Between the 20th and 24th weeks of gestation, the fetal heart sounds are detectable with a fetoscope or stethoscope. This is a really good pregnancy indicator.
  • Investigation
    • X-ray
      • Although the skeletal shadow can be seen as early as 16 weeks, this is not usually done.
    • Sonography
      • This can identify not only the fetal skeleton and organs, but also the placenta's position, the amount of amniotic fluid present, and the internal os's health.

© 2021 Saralmind. All Rights Reserved.