Hello, this is Bing.

I can generate some multiple choice questions for you based on the topic you provided. Here are 10 questions with four options each. The correct answer is marked with
an asterisk (*).

1. Which of the following hormones is used to confirm pregnancy by urine or blood tests?
- A) Progesterone
- B) Estrogen
- C) *Human chorionic gonadotropin (hCG)*
- D) Luteinizing hormone (LH)

2. What is the term for the light bleeding that occurs when the fertilized egg attaches to the lining of the uterus, usually around the time of the expected menstrual period?
- A) *Implantation bleeding*
- B) Breakthrough bleeding
- C) Menstrual bleeding
- D) Ovulation bleeding

3. What is the name of the physical sign that involves bluish discoloration of the cervix due to increased blood flow during pregnancy?
- A) Hegar sign
- B) *Chadwick sign*
- C) Goodell sign
- D) Braxton Hicks sign

4. What is the most common cause of nausea and vomiting during early pregnancy, also known as morning sickness?

Diagnosis of Pregnancy
- A) *Hormonal changes*
- B) Gastric reflux
- C) Food poisoning
- D) Low blood sugar

5. What is the normal range of basal body temperature during early pregnancy?
- A) 35.5°C to 36.5°C
- B) *36.5°C to 37.5°C*
- C) 37.5°C to 38.5°C
- D) 38.5°C to 39.5°C

6. What is the name of the hormone that is produced by the embryo and later by the placenta, and has immunosuppressive and anti-inflammatory properties?

Dr. Ruaa Abdul Jabbar Alnajmawi

- A) *Early pregnancy factor (EPF)*
- B) Corticotropin-releasing hormone (CRH)
- C) Human chorionic thyrotropin (hCT)
- D) Somatostatin (SST)

7. What is the most accurate diagnostic technique for early pregnancy, which allows the provider to look at the pregnancy, uterus, and placenta?
- A) Hormonal evaluation
- B) *Ultrasonography*
- C) Pelvic examination
- D) Fetal heart rate measurement

8. What are the common symptoms of pregnancy that can be attributed to the mechanical changes associated with the growing uterus?

Objectives: Is to understand - A) Mood swings and food aversions

- B) Breast tenderness and tingling
- C) *Frequent urination and constipation*
- D) Fatigue and temperature changes

9. What is the term for the sensation of fetal movement, which can be felt by the mother as early as 16 to 20 weeks of gestation?
- A) *Quickening*
- B) Fluttering
- C) Kicking


- D) Rolling

symptoms & signs of pregnancy. 10. What is the name of the diagnostic procedure that involves inserting a thin needle through the abdomen to obtain a sample of the amniotic fluid, which can be used for genetic testing or
fetal lung maturity assessment?
- A) Chorionic villus sampling (CVS)
- B) *Amniocentesis*
- C) Cordocentesis
- D) Fetoscopy


I hope you find these questions helpful. If you have any feedback or suggestions, please let me know. 😊 .

The methods of diagnosis of pregnancy. Source: Conversation with Bing, 06/01/2024

(1) Symptoms of Pregnancy: 15 Early Signs You Might Notice - Healthline. https://www.healthline.com/health/pregnancy/early-symptoms-timeline.
(2) Symptoms of pregnancy: What happens first - Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/in-depth/symptoms-of-pregnancy/art-20043853.
(3) 14 Very Early Signs of Pregnancy - Parents. https://www.parents.com/pregnancy/signs/symptoms/signs-you-may-be-pregnant/.


(4) What Are the Methods to Diagnose Pregnancy? - iCliniq. https://www.icliniq.com/articles/womens-health/pregnancy-diagnosis.
(5) Clinical manifestations and diagnosis of early pregnancy. https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-early-pregnancy.

Differential diagnosis of pregnancy. (6) Diagnosis of pregnancy | Algorithms for Obstetrics and Gynaecology .... https://academic.oup.com/book/24979/chapter/188913246.
(7) How Do Health Care Providers Diagnose and Treat Pregnancy Loss (Before .... https://www.nichd.nih.gov/health/topics/pregnancyloss/conditioninfo/diagnosed.
(8) en.wikipedia.org. https://en.wikipedia.org/wiki/Multiple_choice.

Introduction:
The reproductive period of a woman begins at menarche and ends in menopause. It
usually extends from 13–45 years. While biological variations may occur in different
geographical areas, pregnancy is rare below 12 years and beyond 50 years.
DURATION OF PREGNANCY: The duration of pregnancy has traditionally been
calculated as (10) lunar months or( 9) calendar months &(7)days or (280) days or (40)
weeks, calculated from the first day of the last menstrual period, this is called menstrual
or gestational age.

FIRST TRIMESTER (FIRST 12 WEEKS)

SUBJECTIVE SYMPTOMS:

1. Amenorrhea during the reproductive period in an healthy individual with normal

periods, is likely due to pregnancy unless proved otherwise. Pregnancy, however, may
occur in women who are previously amenorrheic — during lactation & puberty.
cyclic bleeding may occur up to 12 weeks of pregnancy, until the decidual space is
obliterated by the fusion of decidua vera with decidua capsularis. This type of bleeding
should not be confused with pathological bleeding, i.e. threatened abortion.
1. Morning sickness is present in about 50% cases, more often in the 1st pregnancy. It
usually appears about (6) weeks after LMP rarely lasts beyond the 1ST trimester. It varies
from nausea on rising from the bed to loss of appetite or even vomiting. it usually does
not affect the health status of the mother.
2. Frequency of micturition present at (8–12th )week of pregnancy due to congestion &
pressure on the bladder & disappear after the 1st trimester to reappear again near the end
of pregnancy when the fetal head descends into the maternal pelvis.
3. Breast discomfort in the form of feeling of fullness & ‗pricking sensation‘ is evident as
early as (6–8th) week specially in primigravidae.
4. Fatigue is a frequent symptom which may occur early in pregnancy.
OBJECTIVE SIGNS:
1. Breast changes The breast changes are evident between (6–8 )weeks.& includes
Increase in size & vascularity, Increase pigmentation of the nipple &primary areola.
Appearance of the secondary areola, & Montgomery‘s follicles.Expression of colostrum.
 Breast signs are diagnostic only in primigravidae. In multigravidae, it may be due to the
previous pregnancies.
2. abdominal changes :Uterus remains a pelvic organ until (12th )week, it may be just felt per
abdomen as suprapubic bulge.
3. Pelvic changes :
• Chadwick‘s sign: It is the dusky hue of the vestibule & anterior vaginal wall visible at about
(8th) week of pregnancy, due to local vascular congestion.
• Vaginal signs: The walls become softened with Copious non-irritating mucoid discharge
appears at (6th) week. There is increased pulsation, felt through the lateral fornices at 8th week
called Osiander‘s sign.
• Cervical signs: Cervix becomes soft as early as (6th) week , bluish due to increased vascularity
& hyperatrophied.
• Uterine signs: The uterus becomes enlarged, globular &soft.
Palmer's sign: uterine contractions felt during bimanual examination as early as (4–8) weeks
Hegar's sign: in bimanual examination, fingers in the anterior fornix can be approximated to
fingers of the abdominal hand behind the uterus due to softening & emptiness of the lower
part of the uterus. can be elicited between (6-10) weeks but not later as the growing
conception will fill the whole uterine cavity.
IMMUNOLOGICAL TESTS FOR DIAGNOSIS OF PREGNANCY
Pregnancy tests depend on detection of the antigen human chorionic gonadotrophin (hCG) in
maternal plasma & urine. It is a glycoprotein secreted by the syncytiotrophoblast , composed of
an α & β subunits, which are non covalently linked. The β subunit confers specific activity to
the hormone & is most commonly measured in most pregnancy assays, detection of hCG in
maternal plasma is not possible before implantation has occurred, approximately (10) days after
the LH surge. Typically, the level of β-hCG doubles approximately every (36 )hours & peaks at
about 100,000 mIU/ml at (10 weeks) ' gestation, after which it decreases to about 20,000
mIU/ml by mid-pregnancy, where it remains until term. β-hCG is not diagnostic of normal
pregnancy only: Abnormal elevations, plateaus, or decreasing titers of β-hCG raises the
possibility of ectopic pregnancy or miscarriage. further invistigations such as ultrasound, serum
progesterone levels, or both are needed.
Other uses of pregnancy tests: Apart from diagnosis of intrauterine pregnancy, the tests are
employed in the:
 diagnosis of ectopic pregnancy ,
 to monitor pregnancy following in vitro fertilization & embryo transfer &
 to follow up cases of hydatidiform mole and choriocarcinoma.
ULTRASONOGRAPHY: Intradecidual gestational sac (GS) is identified as early as 29
to 35 days of gestation. Fetal viability & GS is determined by detecting the following
structures by transvaginal ultrasonography.
 Gestational sac & yolk sac by 5 menstrual weeks;
 Fetal pole &cardiac activity — 6 weeks;
 Embryonic movements by 7 weeks.
 Fetal gestational age is best determined by measuring the crown rump length (CRL)
between 7 &12 weeks (variation ± 5 days).
 Doppler effect of ultrasound can pick up the fetal heart rate reliably by 10th week.
,The gestational sac (true) must be differentiated from pseudogestational sac.

SECOND TRIMESTER (13–28 WEEKS)

SUBJECTIVE SYMPTOMS:
1. nausea, vomiting and frequency of micturition usually subside,
2. amenorrhea continues.
3. ―Quickening‖ :the perception of active fetal movements by the women usually felt about the
18th week, about 2 weeks earlier in multiparae. Its appearance is useful guide to calculate the
 Habush 2006

expected date of delivery with reasonable accuracy.

4. Progressive enlargement of the lower abdomen by the growing uterus.

GENERAL EXAMINATION
1. Chloasma: may appear at about 24th week.
2. Breast changes: same as 1st trimester changes but more prominent, Colostrum becomes thick
& yellowish by (16th ) week , Variable degree of striae may be visible with advancing weeks.
ABDOMINAL EXAMINATION
Inspection:
linea nigra may be visible as early as 20th week , Striae gravidarum (both pink & white) are
visible in the lower abdomen, more towards the flanks .
Palpation:
1. Fundal height is increased with progressive enlargement of the uterus. Approximate duration
of pregnancy can be ascertained by noting the height of the uterus in relation to different levels
in the abdomen.
midway between the symphysis pubis & umbilicus at (16th) week;
at the level of umbilicus at( 24th) week ,
at level of xiphisternum at (36th ) weeks.
2. Braxton-Hicks contractions are evident,
3. Palpation of fetal parts can be felt distinctly by (20th )week. Useful in diagnosis of pregnancy
& to identify the presentation & position of the fetus in later weeks.
4. Active fetal movements can be felt at intervals by placing the hand over the uterus as early as
20th week. It not only gives positive evidence of pregnancy but of a live fetus.
Auscultation
1. Fetal heart sound (FHS): is the most conclusive clinical sign of pregnancy. With stethoscope,
it can be detected between (18–20) weeks. The rate is ( 110–160) beats per minute.
Two other sounds are confused with fetal heart sounds :
2. Uterine souffle : is a soft blowing systolic murmur heard low down at the sides of the uterus,
best on the left side. It is synchronous with the maternal pulse &is due to increase in blood flow
through the dilated uterine vessels. It can be heard in big uterine fibroid
3. Funic or fetal souffle is due to rush of blood through the umbilical arteries. It is a soft, blowing
murmur synchronous with the fetal heart sounds.
VAGINAL EXAMINATION:
The bluish discoloration of the vulva, vagina & cervix is much more evident, so also softening of
the cervix
INVESTIGATIONS (Imaging Studies):
1. Routine sonography: at 18–20 weeks permits a detailed survey of fetal anatomy, placental
localization & the integrity of the cervical canal. GA is determined by measuring the biparietal
diameter (BPD), head circumference (HC), abdominal circumference (AC) &femur length (FL).
It is most accurate when done between 12 -20 weeks (variation ± 8 days). Absence of fetal
cardiac motion confirms fetal death.
2. Magnetic Resonance Imaging (MRI): can be used for fetal anatomy survey, biometry &
evaluation of complex malformations , radiologic evidence of fetal skeletal shadow may be
visible as early as( 16th ) week

THIRD TRIMESTER (29-40 WEEKS)

SUBJECTIVE SYMPTOMS:
1. Amenorrhea persists
2. Enlargement of the abdomen is progressive which produces some mechanical discomfort to
the patient such as palpitation or dyspnea following exertion.
3. Lightening : At about 38th weeks, especially in primigravidae, a sense of relief of the pressure
symptoms is obtained due to engagement of the presenting part.
4. Frequency of micturition reappears
5. Fetal movements are more pronounced.
SIGNS:
1. Cutaneous changes are more prominent with increased pigmentation and striae.
2. Uterine shape is changed from cylindrical to spherical beyond 36th week.
3. Symphysis fundal height (SFH): The upper border of the fundus is located by the ulnar border
of the left hand & this point is marked. The distance between the upper border of the symphysis
pubis up to the marked point is measured by a tape in centimeter After (24 )weeks, the SFH
measured in cm corresponds to the number of weeks up to 36 weeks. A variation of ± 2 cm is
accepted as normal. Variation beyond the normal range needs further evaluation
4. Braxton-Hicks contractions are more evident.
5. Fetal movements are easily felt.
6. Palpation of the fetal parts becomes much easier. Lie, presentation & position of the fetus are
determined.
7. Fetal heart sounds (FHS) is heard distinctly in areas corresponding to the presentation &
position of the fetus. FHS may not be audible in cases of maternal obesity, polyhydramnios,
occipitoposterior position & intrauterine fetal death.
INVESTIGATIONS (Imaging Studies):
Sonography : gestational age estimation by BPD, HC, AC &FL is less accurate (variation ± 3
weeks). Fetal growth assessment can be made provided accurate dating scan has been done in 1st
or 2nd trimester. Fetal weight estimation , Amniotic fluid volume assessment to detect
oligohydramnios (amniotic fluid index AFI < 5) or polyhydramnios (AFI > 25). Placental
Location (fundus or previa), &thickness or other abnormalities , other information: Fetal
viability , number, presentation & organ anatomy as done in the 1st & 2nd trimester
DIFFERENTIAL DIAGNOSIS OF PREGNANCY:
(1). Pseudocyesis (Phantom, spurious, false pregnancy): It is a psychological disorder where the
woman has false but firm belief that she is pregnant although no pregnancy exists. The woman
often is infertile who has an intense desire to have a baby. Obstetric examination reveals absence
of positive signs of pregnancy. Examination with ultrasound &\or immunological tests for
pregnancy may be required to negate the diagnosis.
(1) Cystic ovarian tumor: The diagnostic points are; the swelling is slow growing,
usually takes months to grow , Amenorrhea is usually absent , It feels cystic or tense
cystic , Absence of Braxton-Hicks contraction , Absence of positive signs of pregnancy ,
Ultrasonography shows absence of fetus.
(2) Fibroid : The tumor is slow growing, often takes years , Amenorrhea is absent , the feel is
firm, more towards hard but may be cystic in cystic degeneration , Positive signs of
pregnancy are absent , Ultrasonography or immunological test for pregnancy gives
negative result.
(3) Encysted peritonitis : History of Koch‘s infection , Amenorrhea may be present ,
Swelling is ill defined , Absence of positive signs of pregnancy , Internal examination
reveals normal uterus separated from the swelling , US shows absence of fetus.
(4) Distended urinary bladder : In chronic retention of urine due to retroverted gravid uterus,
the distended bladder may be mistaken as ovarian cyst or acute hydramnios.
Catheterization of the bladder solves the problem.
SUMMARY OF DIAGNOSIS OF PREGNANCY:
Positive or absolute signs :
(1) Palpation of fetal parts and perception of active fetal movements at about 20th week .
(2) Auscultation of fetal heart sounds.
(3) Ultrasound evidence of embryo as early as 6th week and later on the fetus
(4) Radiological demonstration of the fetal skeleton at 16th week and onwards.
Presumptive symptoms and signs :
(1) Amenorrhea
(2) Frequency of micturition
(3) Morning sickness
(4) Fatigue
(5) Breast changes
(6) Skin changes
(7) Quickening.
Probable signs :
(1) Abdominal enlargement
(2) Braxton-Hicks contractions
(3) Outlining the fetus
(4) Changes in the size, shape and consistency of the uterus
(5) Softening of the cervix
(6) Osiander‘s sign
(7) Immunological test.
References
1. DC DUTTAS TEXTBOOK OF OBSTETRICS
2. OXFORD HANDBOOK OF OBSTETRICS AND GYNECOLOGY
3. https://images.app.goo.gl/ake6RtDvMYT1czqQ7
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tAhVB0RoKHapuClAQ2-
cCegQIABAC&oq=Osiander+sign&gs_lcp=ChJtb2JpbGUtZ3dzLXdpei1pbWcQAzICC
AAyBAgAEB4yBAgAEB4yBAgAEB4yBAgAEB46BwgjEOoCECc6BAgjECc6BQgA
ELEDOgQIABBDOgQIABANOgYIABANEB5Q_5wOWM6CD2DShA9oA3AAeACA
AZQDiAGVG5IBCjAuMS4xMi4wLjGYAQCgAQGwAQXAAQE&sclient=mobile-
gws-wiz-img&ei=94_TX-H_FMGia6rdqYAF&bih=782&biw=412&client=ms-android-
samsung-ga-rev1&prmd=ivn#imgrc=UKg4lpRBjL1xwM
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tNWfocbtAhXJwIUKHchTBEIQ2-
cCegQIABAC&oq=pregnancy+test&gs_lcp=ChJtb2JpbGUtZ3dzLXdpei1pbWcQAzICC
AAyAggAMgIIADICCAAyAggAOgcIIxDqAhAnOgQIIxAnOgUIABCxAzoECAAQQz
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EuMC40LjEuMS4xmAEAoAEBsAEFwAEB&sclient=mobile-gws-wiz-
img&ei=W5LTX76bAcmBlwTIp5GQBA&bih=782&biw=412&client=ms-android-
samsung-ga-rev1&prmd=imvn#imgrc=3_PqHFH1-GidcM&imgdii=rqlfINZVNHwSoM
6. http://homoeohealthline.blogspot.com/2017/09/homoeopathic-treatment-for-
chloasma.html?m=1
7. https://www.ncbi.nlm.nih.gov/books/NBK436005/figure/article-29544.image.f1/
8. https://www.alamy.com/pregnancy-measurement-of-fundal-height-image7711566.html
9. https://www.brooksidepress.org/Products/Military_OBGYN/Textbook/Pregnancy/fetal_h
eart_beat.htm
10. https://www.fetalultrasound.co.za/2nd-trimester/
11. https://www.medillsb.com/illustration_image_details.aspx?AID=7999&IID=229066