Diagnosis of pregnancy
Doubtful signs of pregnancy come from any systems excluding genital one. They are:
- nausea, vomiting, intorelance to some kinds of odours and tastes
- nervoursness, irritability, emotional lability, drowsness, dizziness
- skin pigmentation on the face, abdomenal median line, the breast papilla area, striae gravidarum
- increase of the abdomen
- breast condensation
These signs are changable and met in different combinations.
Probable signs of pregnancy come from genital and endocrine systems. They are:
- amenorrhea - absence of menstruations in women of reproductive age
- breast increase and colostrum secretion
- vaginal and cervical mucosa cyanosis
- change of uterine consistence, shape and size
The pregnancy is likely to exist, but its probability is not 100%.
Untill 12 weeks of pregnancy the rate of uterine growth is strictly definite that make it possible to establish exactly gestation age. In 5-6 weeks uterine size is equal to the size of a chicken egg, in 8 weeks – a goos egg or a male fist, in 12 weeks – the size of a newborn head and the fundus is at the level of the pubis. Later uterine growth race is very individual.
Uterine shape change. First the uteris increases in the anterior-posterior direction so in 5-6 weeks it becomes pear-shaped. Later it began to grow in the transverse direction, in 8 weeks being globe-shaped. The uterus becomes asymmetric due to the prominence of its wall at the place of the fertilized egg nidation (Piskatchec sign – exists untill 8 weeks). Genter-2 sign – the lengthwise crista on the anterior uterine surface appers.
The next group of signs are due to progesteron influence: the uterine consistence becames softer. The isthmus is the first to change, so it is difficult to reveal it in the vaginal study and the corpus and the cervix are seemed to be separated. Fingers of the interal and external hands are easily reach each other through the abdomenal wall (Govitz-Gegar sign). The uterine corpus mobility is increased (Gubarev-Gaus sign) and the heavy corpus is overbent forward – hyperanteflexio (Genter-1 sign). The pregnant uterus is very irritable and becomes more dense in the process of examination (Snegiryov sign).
Certain signs of pregnancy cone from the fetus and are always present. They are:
- palpation of the large parts of the fetus
- fetal movements
- fetal heart sounds auscultation.
Laboratory diagnostics of pregnancy is based on revealing the special pregnancy hormone – chorilnic gonadotropine which is present in blood and urine. This hormone is produced by the chorion and placenta.
Methods of obstetrical examination
External obstetrical examination – Leopold-Levitsky ways.
1st way – estimation of the uterine fundus height and the large part of the fetus located in the fundus.
2nd way – where are the back and small parts of the fetus (position)
3rd way – the large part of the fetus located at the small pelvic entrace (presenting part)
4th way – relation between the presenting part and the small pelvic entrance.
The head is dense and can be ballotated and the breach part is larger, softer and cannot ce ballotated.
Vaginal study estimates:
- condition of the uterine cervix
- safety of membranes
- presenting part of fetus
- exostoses and pelvic bones deformities, pubic bones diastasis, painfulness in the symphysis area
- diagonal conjugate dimansion
- sutures and fontanelles location (fitting character and fetal position)
- relations between presenting part and pelvic planes.
Having performed the obstetrical examination the conclusion about fetal disposition inside the uterus can be made.
Habitus – relations between different parts of the fetus. Normally fetal trunk is bent, the head is inclined to the thorax, leggs are bent and clasped to the abdomen, hands are crossed on the thorax (posture of embrion). The fetus has ovoid shape. Incorrect habitus: i.g. head extention, hands thrown back.
Situs – relations between fetal and uterine axes. Correct situs (longitudinal) – the axes coinside. Incorrect situs: the axes are crossed making the acute angle (oblique site) or the right one (transverse site).
Presentation – relations between the large part of the fetus and the pelvic entrance. It can be head and breach.
Position – where is the fetal back – to the left (the 1st position) or to the right (the 2nd position). In case of the transverse or the oblique situs position depends on where is the head.
Visus – relations between the fetal back and the anterior or posterior uterine walls. E.g. if the back is at the anterior wall it is the anterior visus.