SIGN OF PREGNANCY AND SCREENING TEST DURING PREGNANCY OBG SYN. 12

📚🩺 Signs of Pregnancy

📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams

✅ I. Introduction / Definition

Pregnancy is identified based on a combination of subjective symptoms and objective clinical findings.
The signs of pregnancy are categorized into Presumptive, Probable, and Positive signs according to their diagnostic value.

✅ “Signs of pregnancy are the observable and subjective indications that suggest or confirm the presence of pregnancy.”

📖 II. Categories of Signs of Pregnancy

🟢 1. Presumptive Signs (Subjective Signs)

Experienced by the woman but not conclusive of pregnancy.
Can be caused by other conditions.

Signs	Description
Amenorrhea	Absence of menstruation; earliest and most common sign.
Nausea and Vomiting	Known as morning sickness; usually in early pregnancy.
Breast Changes	Tenderness, enlargement, darkening of areola.
Fatigue	Feeling of tiredness due to hormonal changes.
Increased Frequency of Urination	Due to uterine pressure on the bladder.
Quickening	First perception of fetal movements (18–20 weeks in primigravida, 16–18 weeks in multigravida).
Skin Changes	Chloasma (mask of pregnancy), Linea nigra, Striae gravidarum (stretch marks).

🟢 2. Probable Signs (Objective Signs)

Observed by the examiner but still not definitive.

Signs	Description
Chadwick’s Sign	Bluish discoloration of vaginal mucosa.
Goodell’s Sign	Softening of the cervix.
Hegar’s Sign	Softening of the lower uterine segment.
Abdominal Enlargement	Visible increase in abdominal size.
Positive Pregnancy Test	Detection of hCG hormone in urine or blood.
Ballottement	Fetus rebounds when tapped during vaginal exam.
Uterine Souffle	Blowing sound heard over uterus, synchronous with maternal pulse.

🟢 3. Positive Signs (Conclusive Signs)

Provide definitive evidence of pregnancy.

Signs	Description
Fetal Heart Sounds	Detected by Doppler at 10–12 weeks or by stethoscope at 18–20 weeks.
Palpation of Fetal Movements	Felt by the examiner after 20 weeks.
Visualization of Fetus	Confirmed by ultrasound as early as 5–6 weeks of gestation.

📚 Golden One-Liners for Quick Revision:

Amenorrhea is the earliest presumptive sign of pregnancy.
Positive signs of pregnancy include fetal heart sounds and ultrasound visualization.
Chadwick’s Sign: Bluish discoloration of vaginal mucosa.
Goodell’s Sign: Softening of the cervix.
Fetal heart sounds can be detected by Doppler as early as 10–12 weeks.

✅ Top 5 MCQs for Practice

Which of the following is a positive sign of pregnancy?
🅰️ Nausea and vomiting
🅱️ Chadwick’s sign
✅ 🅲️ Fetal heart sounds
🅳️ Breast tenderness
Which sign is characterized by softening of the cervix?
🅰️ Hegar’s Sign
✅ 🅱️ Goodell’s Sign
🅲️ Chadwick’s Sign
🅳️ Ballottement
At what gestational age is quickening felt by a primigravida?
🅰️ 12–14 weeks
🅱️ 16–18 weeks
✅ 🅲️ 18–20 weeks
🅳️ 22–24 weeks
Which is a probable sign of pregnancy?
🅰️ Visualization of fetus on ultrasound
✅ 🅱️ Positive pregnancy test
🅲️ Fetal heart sounds
🅳️ Palpation of fetal movements
Chadwick’s sign is due to:
🅰️ Softening of the cervix
🅱️ Softening of the uterine segment
✅ 🅲️ Increased vascularity causing bluish vaginal mucosa
🅳️ Increased pigmentation of the skin

🧪 Screening Tests During Pregnancy

📘 Essential for Antenatal Care, Maternal Health Nursing & Midwifery Exams

✅ I. Introduction / Definition:

Screening tests in pregnancy are used to identify risk factors or early signs of conditions that could affect the mother, fetus, or both, even if there are no symptoms.

✅ “Screening tests during pregnancy are preventive tests used to detect maternal infections, fetal anomalies, chromosomal disorders, and metabolic abnormalities early.”

📅 II. Timing of Screening Tests:

⏰ Trimester	📝 Purpose
1st Trimester	Confirm pregnancy, check for infections and chromosomal risks
2nd Trimester	Detect structural anomalies, screen for gestational diabetes
3rd Trimester	Assess fetal well-being, anemia, infections, Rh status

🧪 III. First Trimester Screening Tests (0–13 weeks):

🧬 Test	📍 Purpose
Urine Pregnancy Test / β-hCG	Confirm pregnancy
Ultrasound (6–9 weeks)	Confirm viability, location (rule out ectopic), gestational age
Nuchal Translucency (NT Scan)	Detect chromosomal anomalies (Down syndrome)
Double Marker Test (Free β-hCG + PAPP-A)	Screen for Trisomy 21/18 risks
Blood Grouping & Rh Typing	Prevent Rh isoimmunization
Hemoglobin, CBC	Detect anemia
HIV, HBsAg, VDRL, Rubella IgG	Screen for infectious diseases
Thyroid Function Test (TSH)	Rule out hypothyroidism
Random Blood Sugar (RBS)	Detect pre-existing diabetes

🧪 IV. Second Trimester Screening Tests (14–28 weeks):

🔍 Test	📌 Purpose
Anomaly Scan (Level 2)	Detailed fetal structural assessment at 18–22 weeks
Triple Marker Test (AFP, β-hCG, Estriol)	Screen for neural tube defects, trisomies
Quadruple Marker Test (+ Inhibin A)	Higher accuracy for chromosomal anomalies
Oral Glucose Tolerance Test (OGTT)	Detect Gestational Diabetes Mellitus (GDM)
Repeat Hemoglobin, Blood Sugar	Monitor maternal status
Urine Routine & Culture	Detect UTI or proteinuria (preeclampsia risk)

🧪 V. Third Trimester Screening Tests (29–40 weeks):

⏳ Test	📌 Purpose
Ultrasound (Growth Scan)	Assess fetal growth, amniotic fluid, and placental function
Non-Stress Test (NST)	Assess fetal well-being and oxygenation
Biophysical Profile (BPP)	Combines NST + USG for fetal breathing, movement, tone
Doppler Ultrasound	In IUGR or high-risk pregnancies – assess blood flow to fetus
Group B Streptococcus (GBS) culture	Detect infection risk at delivery
Repeat CBC, RBS, LFT/KFT	Monitor maternal health status
Anti-D Antibody Titer (if Rh⁻ mother)	Prevent Rh isoimmunization

👩‍⚕️ VI. Nursing Responsibilities:

🟩 Before Testing:
🔹 Educate mother on importance of each screening
🔹 Provide comfort, privacy, and emotional reassurance
🔹 Check consent and lab requisitions

🟨 During Testing:
🔹 Ensure proper sample collection (blood, urine)
🔹 Assist during ultrasonography or OGTT procedure
🔹 Monitor mother for dizziness or discomfort

🟥 After Testing:
🔹 Report abnormal results to obstetrician
🔹 Counsel for follow-up scans or diagnostic tests (e.g., amniocentesis)
🔹 Reinforce nutritional and lifestyle advice

📚 Golden One-Liners for Quick Revision:

🟡 NT scan + Double marker = 1st trimester chromosomal screening
🟡 Anomaly scan is done between 18–22 weeks
🟡 OGTT is the gold standard for diagnosing GDM
🟡 Triple/Quad tests assess risk of Trisomy 21, 18, NTD
🟡 Biophysical Profile includes 5 fetal parameters (NST + USG)

✅ Top 5 MCQs for Practice:

Q1. The NT scan is done in which trimester?
🅰️ Second
✅ 🅱️ First
🅲️ Third
🅳️ Postpartum
Correct Answer: 🅱️ First

Q2. Which test is used to detect gestational diabetes during pregnancy?
🅰️ Random blood sugar
🅱️ Triple test
✅ 🅲️ Oral Glucose Tolerance Test (OGTT)
🅳️ Nuchal translucency scan
Correct Answer: 🅲️ Oral Glucose Tolerance Test (OGTT)

Q3. Anomaly scan is best performed at:
🅰️ 8–10 weeks
🅱️ 12–14 weeks
✅ 🅲️ 18–22 weeks
🅳️ 30–32 weeks
Correct Answer: 🅲️ 18–22 weeks

Q4. Which test combines ultrasound and NST to assess fetal well-being?
🅰️ OGTT
🅱️ NT Scan
✅ 🅲️ Biophysical Profile
🅳️ Amniocentesis
Correct Answer: 🅲️ Biophysical Profile

Q5. The double marker test is used for:
🅰️ Blood grouping
🅱️ Detecting anemia
✅ 🅲️ Screening for chromosomal abnormalities
🅳️ Screening for UTI
Correct Answer: 🅲️ Screening for chromosomal abnormalities

📚📈 Contraction Stress Test (CST)

📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Midwifery/Obstetric Nursing Exams

✅ 1. Introduction / Definition:

The Contraction Stress Test (CST) is a diagnostic procedure used during antenatal care to evaluate fetal well-being, especially the fetus’s ability to tolerate uterine contractions by assessing the fetal heart rate (FHR) response.

“CST is a test to assess fetal oxygenation and placental sufficiency by observing fetal heart rate patterns during uterine contractions.”

✅ 2. Purpose of CST:

Assess uteroplacental function
Detect fetal hypoxia or compromise
Identify the risk of intrauterine fetal death in high-risk pregnancies
Determine if fetus will tolerate labor contractions

✅ 3. Indications:

Post-term pregnancy
Gestational diabetes
Hypertensive disorders of pregnancy
Intrauterine growth restriction (IUGR)
Decreased fetal movements
Non-reactive NST (Non-Stress Test)

✅ 4. Procedure:

🔹 Pre-Test Preparation:

Obtain informed consent
Ensure empty bladder
Position mother in semi-Fowler’s or left lateral position
Attach external fetal monitor and tocodynamometer

🔹 Induction of Contractions:

Nipple stimulation: Encourages natural oxytocin release
Oxytocin infusion (IV Pitocin): Controlled, to stimulate contractions

🔹 Monitoring:

Minimum 3 contractions within 10 minutes
Observe FHR response during and after contractions

✅ 5. Interpretation of Results:

Result	Criteria	Interpretation
Negative CST	No decelerations with contractions	Normal, reassuring
Positive CST	Late decelerations in ≥50% of contractions	Abnormal, fetal compromise
Equivocal CST	Intermittent late or variable decelerations	Unclear, needs further testing
Unsatisfactory CST	Inadequate contractions or poor tracing	Test should be repeated

✅ 6. Advantages:

Helps predict fetal tolerance to labor
Guides decision for induction vs cesarean section
Non-invasive and can be repeated

✅ 7. Limitations and Contraindications:

🔹 Limitations:

Time-consuming
Requires uterine contractions
False positives may occur

🔹 Contraindications (when contractions may harm mother/fetus):

Preterm labor risk
Placenta previa
Previous classical cesarean section
Incompetent cervix
Multiple pregnancy

✅ 8. Nursing Responsibilities:

Explain procedure and provide emotional support
Monitor baseline vitals and FHR before and after test
Administer and regulate oxytocin infusion if needed
Observe for uterine hyperstimulation or fetal distress
Document test findings, contractions, and fetal response
Be prepared to discontinue test and notify physician if complications arise

✅ 9. Golden One-Liners for Quick Revision:

CST evaluates fetal heart response to contractions
Negative CST = normal; Positive CST = late decelerations
Requires 3 contractions in 10 minutes
Avoid in cases like placenta previa or uterine scar
Late decelerations indicate uteroplacental insufficiency

✅ 10. MCQs for Practice:

Q1. The main purpose of CST is to assess:
a) Fetal breathing movement
b) Maternal blood pressure
✅ c) Fetal response to uterine contractions
d) Amniotic fluid volume

Q2. A positive CST indicates:
a) Reassuring fetal status
✅ b) Fetal compromise (late decelerations)
c) Adequate uterine contractions
d) Early fetal movement

Q3. Contraction stress test is contraindicated in:
a) Post-term pregnancy
✅ b) Placenta previa
c) Gestational diabetes
d) IUGR

Q4. Minimum number of contractions needed for CST interpretation is:
a) 1 in 5 minutes
✅ b) 3 in 10 minutes
c) 5 in 10 minutes
d) 2 in 5 minutes

Q5. CST is performed using:
a) Amniocentesis
✅ b) Nipple stimulation or oxytocin
c) Magnesium sulfate
d) Fundal height measurement

📚📈 Non-Stress Test (NST)

📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Midwifery/Obstetric Nursing Exams

✅ 1. Introduction / Definition:

Non-Stress Test (NST) is a non-invasive antenatal test that evaluates fetal well-being by monitoring the fetal heart rate (FHR) in response to fetal movements in the absence of uterine contractions.

“NST is based on the principle that a healthy fetus will have temporary accelerations in heart rate with fetal movement, indicating an intact central nervous system and adequate oxygenation.”

✅ 2. Purpose:

Assess fetal oxygenation and well-being
Detect fetal distress in high-risk pregnancies
Monitor fetal CNS function
Guide decision for delivery timing or intervention

✅ 3. Indications:

Decreased fetal movements
Post-term pregnancy (>40 weeks)
Hypertensive disorders in pregnancy
Gestational diabetes mellitus
IUGR (Intrauterine Growth Restriction)
Oligohydramnios / Polyhydramnios
Rh isoimmunization
History of previous stillbirth

✅ 4. Procedure:

🔹 Preparation:

Explain the procedure to the mother
Ensure empty bladder
Position mother in semi-Fowler’s or left lateral position

🔹 Monitoring:

Attach external fetal heart monitor (Doppler) and uterine tocodynamometer
Duration: 20–40 minutes
Mother may be asked to press a button each time she feels fetal movement

✅ 5. Interpretation of NST:

Result	Criteria	Meaning
Reactive NST (Normal)	≥2 accelerations of ≥15 bpm lasting ≥15 seconds within 20 minutes	Normal fetal status
Non-Reactive NST	No adequate accelerations in 40 minutes	May indicate fetal hypoxia or sleep; needs further evaluation
Unsatisfactory NST	Poor tracing or inadequate movement	Repeat or use other tests (e.g., BPP)

✅ 6. Acceleration Definition:

Increase in fetal heart rate by ≥15 bpm over baseline
Lasting ≥15 seconds
Counted only if occurs with fetal movement

✅ 7. Advantages:

Simple, non-invasive, and painless
No risk to mother or fetus
Can be repeated as often as needed
Helps in timely intervention to prevent fetal loss

✅ 8. Limitations:

False non-reactivity due to fetal sleep cycle
Less effective in preterm fetuses (<32 weeks)
May require further testing (CST or BPP) if non-reactive

✅ 9. Nursing Responsibilities:

Educate and reassure the mother
Monitor fetal heart rate and maternal vitals
Encourage light food or juice to stimulate fetal movement
Document start/end time, fetal movements, and FHR pattern
Report non-reactive or abnormal results to physician immediately

✅ 10. Golden One-Liners for Quick Revision:

NST = Non-invasive assessment of fetal well-being
Reactive NST = 2 accelerations ≥15 bpm for ≥15 seconds in 20 mins
Non-reactive NST requires follow-up (CST or BPP)
NST is commonly used in high-risk pregnancies
Position mother in left lateral to avoid supine hypotension

✅ 11. MCQs for Practice:

Q1. The main purpose of NST is to assess:
a) Uterine contractions
b) Placental location
✅ c) Fetal well-being
d) Amniotic fluid

Q2. A reactive NST shows:
a) Late decelerations
b) No fetal movements
✅ c) At least 2 accelerations in 20 mins
d) Bradycardia

Q3. The ideal maternal position during NST is:
a) Supine
✅ b) Left lateral
c) Prone
d) Sitting

Q4. In NST, fetal heart rate acceleration is defined as:
a) 5 bpm rise for 10 sec
✅ b) 15 bpm rise for 15 sec
c) 10 bpm rise for 5 sec
d) 20 bpm rise for 20 sec

Q5. NST is considered non-reactive when:
a) 3 accelerations occur
✅ b) No adequate accelerations occur in 40 minutes
c) Uterine contractions are absent
d) Fetal movement is excessive

📚👣 Fetal Movement Count (FMC)

📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Midwifery/Obstetric Nursing Exams

✅ 1. Introduction / Definition:

Fetal Movement Count (FMC) is a simple, non-invasive method by which a pregnant woman counts her baby’s movements in the womb to assess fetal well-being, especially in the third trimester.

“Fetal movement count is the mother’s daily recording of fetal kicks or movements to ensure the fetus is active and healthy, and to detect early signs of fetal distress.”

✅ 2. Purpose of FMC:

To assess fetal well-being
To detect reduced fetal movements, which may indicate hypoxia or distress
Useful in high-risk pregnancies: hypertension, diabetes, IUGR, post-term
Encourage maternal bonding and awareness

✅ 3. Initiation and Timing:

Begin counting after 28 weeks of gestation
Best time: 1 hour after meals
Position: Left lateral recumbent position (increases uterine perfusion)

✅ 4. Recommended FMC Methods:

🔹 A. Cardiff Count-to-10 Method:

Count fetal movements until 10 movements are felt
Normally, 10 movements are felt within 2 hours

🔹 B. Daily Fetal Movement Record (DFMR):

Record total number of movements in 12 hours
Normal: >10 movements in 12 hours

🔹 C. Modified Sadovsky Method:

Count for 1 hour after a meal, ideally 3 times per day
Normal: ≥3 movements per session

✅ 5. Normal and Abnormal Findings:

Finding	Interpretation
≥10 movements in 2 hrs	Normal fetal activity
<10 movements in 12 hrs	May indicate fetal hypoxia
No movement in 12 hrs	Urgent evaluation needed
Sudden increase followed by decrease	Sign of fetal compromise

✅ 6. Causes of Decreased Fetal Movements:

Fetal sleep cycle
Maternal sedation, obesity
Placental insufficiency
Oligohydramnios
Fetal distress, IUGR, or stillbirth

✅ 7. Nursing Responsibilities:

Educate pregnant women on how and when to count
Encourage daily monitoring from 28 weeks onward
Instruct to report immediately if movements are decreased or absent
Record findings in ANC card or movement chart
Coordinate for further evaluation (NST, USG, Doppler) if abnormalities found

✅ 8. Advantages of FMC:

Simple, free, and effective method
Encourages maternal awareness
Early identification of fetal compromise
Reduces chances of stillbirth in high-risk pregnancies

✅ 9. Limitations:

Subjective and depends on maternal perception
May be difficult in obese or busy women
Affected by fetal position, gestational age, placental site

✅ 10. Golden One-Liners for Quick Revision:

Start FMC at 28 weeks
Cardiff method = 10 movements in 2 hours
<10 movements in 12 hours = abnormal
Left lateral position is best for FMC
Reduced movements may indicate fetal distress or hypoxia

✅ 11. MCQs for Practice:

Q1. Fetal movement count should ideally be started after:
a) 20 weeks
b) 24 weeks
✅ c) 28 weeks
d) 32 weeks

Q2. In Cardiff method, how many fetal movements are expected in 2 hours?
a) 5
b) 8
✅ c) 10
d) 15

Q3. A mother reports no fetal movement for 12 hours. What is the immediate action?
a) Tell her to eat and rest
b) Wait another 24 hours
✅ c) Refer for urgent evaluation (NST/USG)
d) Repeat count next day

Q4. The best position for a mother during fetal movement count is:
a) Supine
✅ b) Left lateral
c) Prone
d) Right lateral

Q5. Which of the following may cause reduced fetal movements?
a) Good nutrition
✅ b) Placental insufficiency
c) Maternal activity
d) Multiparity

📚🖥️ Ultrasonography (USG) in Pregnancy

📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Midwifery/Obstetric Nursing Exams

✅ 1. Introduction / Definition:

Ultrasonography (USG) is a non-invasive diagnostic imaging technique that uses high-frequency sound waves to visualize the fetus, placenta, amniotic fluid, and maternal pelvic structures during pregnancy.

“Obstetric ultrasonography is an essential prenatal tool to assess fetal development, detect abnormalities, and monitor the health of both mother and fetus.”

✅ 2. Types of Obstetric Ultrasound:

Type	Use
Transabdominal USG	Standard, uses abdominal probe on mother’s abdomen
Transvaginal USG	High-resolution; used in early pregnancy or for cervical assessment
Doppler USG	Evaluates blood flow in umbilical cord, fetal vessels
3D/4D USG	Detailed visualization of fetal structures and movements

✅ 3. Indications for USG in Pregnancy:

Confirm intrauterine pregnancy
Determine gestational age and EDD
Assess fetal growth and well-being
Detect multiple gestation
Identify congenital anomalies
Evaluate placental position and function
Measure amniotic fluid volume (AFI)
Monitor fetal movement, presentation, and heart rate
Guide procedures like amniocentesis

✅ 4. Key Ultrasound Scans by Trimester:

Trimester	Scan	Purpose
1st (6–12 weeks)	Dating Scan	Confirm pregnancy, detect heartbeat, calculate EDD
2nd (18–22 weeks)	Anomaly Scan (Level 2)	Detect structural anomalies, fetal organs, spine, heart
3rd (28–32 weeks)	Growth Scan	Monitor fetal growth, position, placenta, AFI, Doppler

✅ 5. Biophysical Parameters Measured:

Gestational sac and Crown-Rump Length (CRL)
Biparietal Diameter (BPD)
Femur Length (FL)
Abdominal Circumference (AC)
Estimated Fetal Weight (EFW)
Placental location and maturity
Amniotic Fluid Index (AFI)
Fetal Heart Rate (FHR)

✅ 6. Normal Ranges (Selected):

Parameter	Normal Value
AFI	8–18 cm
FHR	110–160 bpm
CRL at 12 weeks	~55 mm
BPD at 20 weeks	~48 mm

✅ 7. Advantages of USG:

Safe for mother and fetus (no radiation)
Non-invasive and painless
Repeated use possible
Helps detect early abnormalities and complications
Used to guide obstetric procedures

✅ 8. Limitations:

Operator-dependent
Not all anomalies are detectable
May not detect chromosomal disorders without combined testing
Maternal obesity or fetal position may limit accuracy

✅ 9. Nursing Responsibilities:

Explain procedure to reduce anxiety
Instruct mother to have full bladder for early pregnancy scan
Assist in positioning and provide privacy
Document findings and follow-up
Educate mother on importance of scheduled scans
Support if abnormal findings are identified

✅ 10. Golden One-Liners for Quick Revision:

Dating scan is done at 6–12 weeks
Anomaly scan at 18–22 weeks is critical for detecting defects
Doppler USG assesses fetal circulation
AFI <5 cm = oligohydramnios, AFI >24 cm = polyhydramnios
USG is the safest and most used imaging method in pregnancy

✅ 11. MCQs for Practice:

Q1. The dating scan is ideally done between:
a) 4–6 weeks
b) 10–16 weeks
✅ c) 6–12 weeks
d) 20–24 weeks

Q2. The anomaly scan is typically performed at:
a) 10–12 weeks
✅ b) 18–22 weeks
c) 28–32 weeks
d) At term

Q3. What does a Doppler ultrasound measure in pregnancy?
a) Amniotic fluid
✅ b) Blood flow in fetal vessels
c) Gestational age
d) Placental weight

Q4. Which of the following is a normal AFI range?
a) 2–5 cm
b) 5–8 cm
✅ c) 8–18 cm
d) 18–25 cm

Q5. Transvaginal ultrasound is preferred in:
a) Third trimester
✅ b) Early pregnancy
c) During labor
d) For placenta previa only

Published May 25, 2025By mynursingapp

Categorized as OBG-PHC-SYNOPSIS, Uncategorised