Positive signs of pregnancy
A positive diagnosis of pregnancy can be made on the basis of these signs, which are sometimes called 'sure' signs. They cannot generally be detected until after the first 3 months of pregnancy.
Fetal heart tones (FHTs)
The normal fetal heart rate is 120-160 beats per minute. The heartbeat may be detected from 18-20 weeks' gestation by placing a fetoscope (Figure 8.3) on the woman's belly and listening. You will learn how to do this in Study Session 11 and your practical skills training. Hospitals sometimes have a machine called a hand-held Doppler that can detect fetal heart tones as early as 10 weeks' gestation.
Palpation of the fetus
You should be able to feel (palpate with your hands) fetal movements through the mother's abdominal wall at about 18 weeks of pregnancy, and after 22 weeks the fetal outline can be felt. You will learn how to do this in Study Sessions 10 and 11 and your practical skills training.
Ultrasound examination (or sonography) is one of the most useful technical aids in diagnosing and monitoring pregnancy, but it can only be done in a health facility with the right equipment. Sound waves that are so high you cannot hear them are passed through the mother's abdomen by the machine and they 'bounce' back off the baby. A computer turns these sound waves into an image of the fetal outline; the placenta and umbilical cord can also be seen. Fetal wellbeing can be monitored by ultrasound as the pregnancy progresses.
Which of the signs and symptoms of pregnancy in Sections 8.2.1 to 8.2.3 can you use in your kebele to help you diagnose pregnancy at the community level?
You can base your diagnosis on a combination of the possible symptoms that women tell you about (amenorrhoea, breast changes, nausea and vomiting, especially morning sickness, frequent urination, tiredness in the daytime, quickening of the fetus, and chloasma); and the probable signs and symptoms of abdominal enlargement and the woman experiencing painless uterine contractions. The positive signs that you can detect at community level at 18 to 22 weeks' gestation are hearing fetal heart tones with a fetoscope, and palpating the fetus through the mother's abdominal wall.
Activity 8.1 Asking questions about possible symptoms of pregnancyAllow about 10 minutes for this activity.
In your Study Diary, write down the questions you would ask a woman if you are trying to find out if she is possibly pregnant. Remember to use respectful language and words that she will understand.
Discuss your questions with your Tutor at your next Study Support Meeting.
This activity relates to Self-Assessment Question 8.5 at the end of this study session.