DIAGNOSIS OF PREGNANCY AND PRENATAL CARE

The correct early diagnosis of pregnancy is often urgent. For example, a diagnosis is essential to institute studies or treatment of problems that may jeopardize the life or health of mother or offspring. Today this is usually accomplished by early beta-subunit hCG testing or ultrasonic scanning because a definite clinical diagnosis of pregnancy before the second missed period is possible in only about two thirds of patients. However, the practitioner must be familiar with the signs and symptoms of pregnancy to properly test for and treat the early pregnancy. . | DIAGNOSIS OF PREGNANCY AND PRENATAL CARE The correct early diagnosis of pregnancy is often urgent. For example a diagnosis is essential to institute studies or treatment of problems that may jeopardize the life or health of mother or offspring. Today this is usually accomplished by early beta-subunit hCG testing or ultrasonic scanning because a definite clinical diagnosis of pregnancy before the second missed period is possible in only about two thirds of patients. However the practitioner must be familiar with the signs and symptoms of pregnancy to properly test for and treat the early pregnancy. CLINICAL DIAGNOSIS OF PREGNANCY Traditionally the clinical criteria for the diagnosis of pregnancy have been categorized into presumptive probable and positive Table 5-1 . The differential diagnosis of the common signs and symptoms of pregnancy involves other conditions associated with similar complaints or alteration Table 5-2 . PELVIC FINDINGS OF EARLY PREGNANCY Critical to the diagnosis of pregnancy by physical examination are the pelvic findings. The presumptive indications of pregnancy include the following. Cyanosis of the vagina Chadwick s sign Jacquemier s sign is present by about 6 weeks. 103 Copyright 2001 The McGraw-Hill Companies. Click Here for Terms ofUse. 104 BENSON PERNOLL S HANDBOOK OF OBSTETRICS AND GYNECOLOGY TABLE 5-1 PRESUMPTIVE OR PROBABLE SIGNS AND SYMPTOMS OF PREGNANCY Symptoms Signs Amenorrhea Nausea vomiting Breast tingling mastalgia Urinary frequency urgency Quickening Leukorrhea Changes in color consistency size or shape of cervix or uterus Temperature elevation usually by BBT Enlargement of abdomen Breasts enlarged engorged nipple discharge Pelvic souffle bruit Uterine contractions with enlarged corpus Although these may be suggestive even 2 are not diagnostic of pregnancy. Softening of the tip of the cervix Fig. 5-1 occasionally is noted by the 4th-5th week of pregnancy. However infection or scarring may prevent softening until late .