Diagnosis of pregnancy

1. Amenorrhea is usually the first sign of conception. Other symptoms include breast fullness and tenderness, skin changes, nausea, vomiting, urinary frequency, and fatigue.

2. Pregnancy tests. Urine pregnancy tests may be positive within days of the first missed menstrual period. Serum beta human chorionic gonadotropin (HCG) is accurate up to a few days after implantation.

3. Fetal heart tones can be detected as early as 11-12 weeks from the last menstrual period (LMP) by Doppler. The normal fetal heart rate is 120-160 beats per minute.

4. Fetal movements ("quickening") are first felt by the patient at 17-19 weeks.

5. Ultrasound will visualize a gestational sac at 56 weeks and a fetal pole with movement and cardiac activity by 7-8 weeks. Ultrasound can estimate fetal age accurately if completed before 24 weeks.

6. Estimated date of confinement. The mean duration of pregnancy is 40 weeks from the LMP. Estimated date of confinement (EDC) can be calculated by Nagele's rule: Add 7 days to the first day of the LMP, then subtract 3 months.

B. Contraceptive history. Recent oral contraceptive usage often causes postpill amenorrhea, and may cause erroneous pregnancy dating.

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